人工智能视网膜微血管分析在糖尿病并发症中的应用价值

目的 探讨人工智能视网膜微血管指标分析在糖尿病视网膜病变(DR)、糖尿病肾病(DN)等糖尿病并发症诊断中的应用价值。方法 选取2022年1-12月健康医学科和内分泌科共305例受检者作为研究对象,并根据糖尿病及并发症情况分为健康对照组(n=119)、糖尿病无DR组(n=100)、糖尿病并发DR组(n=86)。糖尿病并发DR组进一步分为无DN组(n=50)与并发DN组(n=36)。收集所有受试者的临床资料、实验室检查指标及眼底照相检查结果。本研究采用独立样本t检验、Kruskal-Wallis H检验、logistic回归分析进行数据统计分析。结果 三组间FBG、2hPBG、HbA1c、视网膜中央动脉当量(CRAE)、视网膜动静脉比值(AVR)差异有统计学意义(P <0.05)。糖尿病并发DR的患者中,无DN组与并发DN组的糖尿病病史、出血总个数、渗出总面积、渗出最大面积及渗出总个数差异有统计学意义(均P <0.05)。视网膜微血管指标与DN存在相关性,当视网膜出血总面积、渗出总面积、渗出最大面积增加时,DN患病风险上升。结论 AI视网膜微血管分析对糖尿病患者并发症的情况有提示和辅助诊断的价值。

绝经后女性2型糖尿病合并高尿酸血症的相关因素研究

目的探讨绝经后女性2型糖尿病(T2DM)患者合并高尿酸血症(HUA)的相关因素。方法选取绝经后女性T2DM患者365例,依据女性血尿酸是否≥360μmol/L,分为正常尿酸(NUA)组316例和HUA组49例。分析2组临床相关指标及糖尿病慢性并发症和合并症的差异。结果与NUA组比较,HUA组糖尿病视网膜病变(61.2%vs 45.6%)、糖尿病肾病(67.3%vs 12.3%)、颈动脉粥样硬化斑块(65.3%vs 44.9%)、高血压(73.5%vs52.5%)、冠心病(34.7%vs 18.7%)及脂肪肝(61.2%vs 47.5%)的发病率明显升高(P<0.05,P<0.01)。多元线性回归分析显示,糖化血红蛋白(β=-0.207,P=0.026)、糖尿病病程(β=0.166,P=0.018)、LDL-C(β=0.184,P=0.009)、肌酐(β=0.356,P=0.002)是HUA的独立影响因素。结论绝经后女性T2DM合并HUA患者有较高的大小血管并发症的发生率。

胎盘生长因子在早产儿视网膜病变纤维血管膜中的表达

目的研究胎盘生长因子(placental growth factor,PLGF)在早产儿视网膜病变(retinopathy of prematurity,ROP)纤维血管膜的血管内皮细胞、周细胞、巨噬细胞和胶质细胞中的表达和分布。方法玻璃体切割术中取ROP患者视网膜表面纤维血管膜保存备用,冰冻切片,HE染色、免疫组织化学染色和免疫荧光染色观察PLGF在纤维血管膜上的表达和分布。结果 HE染色及免疫组织化学染色结果显示PLGF在纤维血管膜中可见阳性表达。免疫荧光双标记法实验结果显示纤维血管膜的PLGF可能由血管内皮细胞、周细胞、巨噬细胞和胶质细胞表达。结论 PLGF可能参与了ROP的发病过程,PLGF在ROP发病中的作用及其分子机制需要进一步研究。

Diabetic macular edema:Current management 2013

Diabetic retinopathy(DR)is the leading cause of vision loss of working-age adults,and diabetic macular edema(DME)is the most frequent cause of vision loss related to diabetes.The Wisconsin Epidemiologic Study of Diabetic Retinopathy found the 14-year incidence of DME in type 1 diabetics to be 26%.Similarly the Diabetes Control and Complications Trial reported that 27% of type 1 diabetic patients develop DME within9 years of onset.The most common type of diabetes,type 2,is strongly associated with obesity and a sedentary lifestyle.An even higher incidence of macular edema has been reported in older patients with type 2diabetes.Within the last 5 years,the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor(VEGF)agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown improved effectiveness of ranibizumab compared to focal/grid laser.In this theme issue,we discuss the classification of DR and the treatment options currently available for the treatment of DME including corticosteroids,anti-VEGF agents,combined therapy,enzymatic vitrectomy(vitreolysis),and new therapies.

Neovascular Glaucoma: An Update on Etiopathogenesis, Diagnostics and Management

Neovascular glaucoma (NVG) is a severe secondary and refractory *severe secondary conditio, that accounts for a varying prevalence between 0.01% to 5.1% of all glaucoma those studied in different regions of the world. **This is a pathological condition, which is caused by the new vessels over iris surface and followed by fibrovascular membrane formation over the trabecular meshwork, secondary to a local angiogenic stimulus. The fibrovascular membrane over trabecular meshwork obstructs the aqueous outflow at an angle of the anterior chamber. ***The obstruction in outflow of the aqueous results increase of intraocular pressure (IOP), within the eyeball. NVG results from a number of ocular and systemic conditions with retinal ischemia leading to anoxia as a mediator in over 95% of cases. Most of them are affected with proliferative diabetic retinopathy (PDR) followed by central retinal venous occlusion (CRVO), and ocular ischemic syndrome (OIS) along with other uncommon causes or all those causes that causes retinal anoxia which led to angiogenic activity in retina and iris of eye. Although NVG overall prevalence is low, but it is a dreadful condition led to blindness. The objective of this review is to provide detailed information on its basic and clinical aspects, to enable us to manage it logically. Here its etiopathogenesis, methods of early diagnosis and management are discussed. It was concluded that if NVG is detected earlier and managed systematically (both medical and surgical) along with an eye on alleviation of different aggravating factors of the retinal hypoxia, it could be a sight-saving measure to the affected person.

巴西南部第三中心早产儿视网膜病变(英文)

目的:评估2002-10/2006-10在巴西de Clinicasde Porto Alegre医院出生的所有早产儿的早产儿视网膜病变(ROP)的发生率,其治疗和预后的比率。方法:对323例出生体质量低于或等于1500g或者出生时孕龄等于或者少于32wk的早产儿进行前瞻性队列研究。所有的新生儿都在出生后6wk内进行开睑器开睑,瞳孔散大,间接检眼镜及28D透镜眼底检查,根据疾病的分类进行复查。结果由均数表示,发病率为于95%的可信区间,主要的临床结果为任何分期的ROP发生。结果:新生儿82例发生了ROP,发生率为25.7%。患者中只有17例((5.3%)发生了阈病变,他们的病变都累及后部第II区,需要激光治疗。除了3例经治疗的患儿需要两次激光治疗外,没有一个经过治疗的患儿有I区病变或者严重的后部病变。重复治疗组的1例患儿因发展成为4期ROP而需要行赤道部硅胶带巩膜环扎术。结论:ROP的发生率和阈病变同国际其它的研究结果类似。本研究显示了孕期28wk以内或出生后体重1000g的新生儿高生存率(70.1%)、高视网膜病变发病率和激光治疗的高度必要性。这组患儿需要眼科专家和新生儿专家为发现ROP进行仔细筛查和随访。本组患儿中没有确诊1例有I区后部病变,此点是本研究值得引起注意之处。

全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层厚度的影响

目的探讨并分析糖尿病视网膜病变（diabeticretinopathy，DR），重度非增生性DR（non—proliferativediabeticretinopathy，NPDR）和早期增生性DR（proliferativediabeticretinopathy，PDR）患者全视网膜光凝术（panretinalphotocoagulation，PRP），术前及术后6个月视盘周围视网膜神经纤维层（RetinalNerveFiberLayer，RNFL）厚度的变化。方法临床病例对照研究。对2010年5月至2011年5月在沧州眼科医院应用光学相干断层扫描技术（opticalcoherencetomography，OCT）测量已确诊的共53例（93只眼），其中重度NPDR组26例和早期PDR组27例，测其PRP前后视盘周围RN．FL的厚度，采用单因素方差分析对PRP前后视盘周围各象限及全周平均RNFL厚度进行两两比较分析。结果重度NPDR和早期PDR组PRP术后6个月上、下象限及视盘周围平均RNFL厚度较薄，与术前比较差异有统计学意义。术后6个月上方、下方及鼻侧象限早期PDR组较重度NPDR组变薄，两者比较差异有统计学意义。结论激光光凝前应充分考虑其对视网膜RNFL的影响，PRP后6个月视盘周围RNFL厚度变薄，尤以上、下象限及全周平均RNFL较明显。