综述

糖尿病视网膜病变的全科医学管理

General practice management of diabetic retinopathy

:350-359
 
糖尿病视网膜病变是糖尿病引起的微血管病变之一,是不可逆性致盲的眼病。根据其病程可分为根据其病程可分为非增殖期和增殖期,其中还包括糖尿病性黄斑水肿。全科医师需要检测量裸眼视力、矫正视力和眼压,通过裂隙灯显微镜评估眼前节以及眼底检查来评估眼部整体情况。控制血糖、血压、血脂对改善预后很重要。需要重视餐前、餐后血糖,糖化血红蛋白和代谢记忆,一线降血压药物包括血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体阻断剂,调脂药物首选他汀类,而非诺贝特有额外的视网膜保护作用。干预生活方式,宣教,早期发现也同样重要。全科医师需要进行眼底筛查和评分,及时转诊至眼科治疗。眼科治疗包括全视网膜激光光凝术、经平坦部玻璃体切除术、玻璃体抗血管内皮生长因子药物注射术。
Diabetic retinopathy is one of the microvascular diseases caused by diabetes, it is an irreversible blindness eye disease. According to its course, it can be divided into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy, including diabetic macular edema. Te general practitioner needs to measure the uncorrected visual acuity, corrected visual acuity intraocular pressure, use the slit lamp microscope to exam the anterior segment and fundus to evaluate the overall condition of the eye. Controlling blood glucose, blood pressure and blood lipid is very important to improve the prognosis. Attach importance to pre- and postprandial blood glucose, glycosylated hemoglobin and metabolic memory should be carried out. The first-line antihypertensive drugs are angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Statins are the first choice for lipid-lowering drugs, fenofibrate has additional protective efect of retinal. Intervention in lifestyle, education and early detection are is important. Te general practitioner needs to perform fundus screening and scoring, timely refer to ophthalmology department for treatment. Ophthalmic treatment includes panretinal laser photocoagulation, pars plana vitrectomy, and intravitreal injection of anti-vascular endothelial growth factor drugs.
综述

晶状体诱导性青光眼的诊治进展

Progress in diagnosis and treatment of lens-induced glaucoma

:827-834
 
晶状体诱导性青光眼(lens-induced glaucoma,LIG)是因晶状体蛋白相关或解剖学异常引起的一类继发性青光眼。基于发病机制,分为晶状体溶解性青光眼、晶状体颗粒性青光眼、晶状体过敏性青光眼、晶体膨胀性青光眼、瞳孔阻滞性青光眼等几类,房角可能是开放或关闭的。高分子量晶状体蛋白、晶状体颗粒释放、瞳孔阻滞、晶体体积增大是引起青光眼的机制。其病因包括膨胀期、成熟期或过熟期白内障,眼部手术和外伤,各种晶体脱位等。流行病学在发达国家和发展中国家各不相同。以视力下降、眼红、单侧眼痛等为主要临床表现,可产生青光眼性不可逆视功能损害。眼部超声检查对其诊断有帮助。需要和急性闭角型青光眼、睫状环阻滞性青光眼、脉络膜上腔出血、外伤或术后眼内炎等疾病相鉴别。治疗方法是去除晶体刺激物质,从而控制眼压。
Lens-induced glaucoma (LIG) is a kind of secondary glaucoma caused by lens proteins or anatomic abnormality of the lens. Based on the pathogenesis, LIG is classified as phacolytic glaucoma, lens-particle induced glaucoma, phacoanaphylactic glaucoma, phacomorphic glaucoma, pupillary block glaucoma. The angle may be open or closed. High-molecular-weight lens protein, release of lens particles, and pupillary block, increase in the volume of the cataractous lens are the mechanisms of glaucoma. Its pathogensis includes intumescent cataracts, mature senile cataract, hyper-mature senile cataracts, surgery and trauma in eyes, and dislocation of lens. The epidemiology varies across developed and developing countries. The common symptom includes diminution of vision, redness of the eye, and unilateral eye pain. It can cause glaucomatous irreversible visual impairment. Ocular ultrasonography is helpful for its diagnosis. Differential diagnosis includes acute angle-closure glaucoma, ciliary block glaucoma, supra-choroidal hemorrhage, post-traumatic or postoperative endophthalmitis. The management is the removal of inciting lenticular matter to control intraocular pressure
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
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