目的：探讨全视网膜光凝及术后应用羟苯磺酸钙治疗糖尿病视网膜病变的疗效。方法：选取96例患者，共175只眼，随机分为对照组(48例，86只眼)和研究组(48例，89只眼)。两组均予全视网膜激光光凝治疗，其中研究组术后再予羟苯磺酸钙继续12周治疗。12周后，观察两组患者治疗前后视力、血液流变学的变化。结果：治疗后研究组在视力>1.0范围的患者明显多于对照组(χ²=6.779，P=0.009)， 而2组在视力≤0.4，0.4~0.6，0.7~1.0范围患者视力差异比较分别为( χ²=0.003，P=0.955)，(χ²=1.640，P=0.200)，(χ²=2.148，P=0.143)。治疗后研究组患者的血浆粘度、红细胞压积、红细胞变形指数、纤维蛋白原改善均优于对照组(P<0.05)。研究组总有效率89.9%，对照组75.6%，两组差异比较(χ² =6.302，P=0.012)。结论：全视网膜激光光凝及术后应用羟苯磺酸钙治疗糖尿病性视网膜病，能有效提高视力及临床疗效，可能与改善患者血液流变相关。

Objective: To investigate the curative effect of the postoperative retinal laser photocoagulation and calcium dobesilate in the treatment of diabetic retinopathy. Methods: Selected 96 patients, 175 eyes, randomly divided into control group (48 cases, 86 eyes) and study group (48 cases, 89 eyes). Two groups were all given retinal laser photocoagulation treatment, while the study group continued to receive calcium dobesilate for 12 weeks after treatment. After 12 weeks, observed the eyesight, change of blood rheology of the two groups. Results: After the treatment, the patients with vision >1.0 in the study group were significantly more than the control group (χ² =6.779, P=0.009), in the vision range of ≤0.4, 0.4~0.6, 0.7~1.0, the difference between the two groups was (χ² =0.003, P=0.955), (χ² =1.640, P=0.200), (χ²=2.148, P=0.143), respectively. After treatment, plasma viscosity, erythrocyte deposited, erythrocyte deformation index, fibrinogen in the study group were better than those in the control group (P<0.05). The total effectiveness in the study group was 89.9%, in the control group was 75.6%, the difference was statistically significant (χ²=6.302, P=0.012). Conclusion: The whole retinal laser photocoagulation and postoperative application of calcium dobesilate in treating the diabetic retinopathy can effectively improve eyesight and clinical curative effect, which may be associated with improving blood rheology.

目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。

目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。

目的:研究增殖性糖尿病视网膜病变患者玻璃体基质细胞衍生因子(Strmalcell-derivedfactor-1, SDF-1)和血管内皮生长因子(Vascular endothelial growth factor, VECF)的浓度,及其相互作用关系。

方法:酶联免疫吸附法(Enzyme-linked immunosorbent assay, ELISA)检测玻璃体内 SDF-1 和 VEGF 的含量,每个标本重复3次。实验组为增性糖尿病视网膜病变(Proliferalive diabeticretinopathy, PDR)的住院患者30例,对照组为同期行玻璃体切除术的特发性黄斑裂孔患者12例。

结果: PDR 患者玻璃体 VECF 的平均浓度为(2865.87+387.85) pg/ml,明显高于特发性黄斑裂孔组[(142.42+21.03) pg/ml，P < 0.0001]。增殖性糖尿病视网膜病变患者玻璃体 SDF-1的含量平均为(298.40+24.57) pg/ml,对照组为(86.91+15.89) pg/ml,两组的差异具有统计学意义(P < 0.0001)。在30例PDR患者玻璃体内 VEGF 和 SDF-1 的含量表现为正相关(Peanson相关系数 r=0.62，P < 0.001)。

结论:增殖性糖尿病患者玻璃体 SDF-1 和 VECF 的含量均高于非糖尿病患者,提示 SDF-1 和 VEGF 共同参与了增殖性糖尿病视网膜病变患者病理性新生血管的形成过程。

Purpose: To investigate the levels of stromal cell-derived factor-1(SDF-1) andvascular endothelial growth factor (VEGF) in the vitreous of patients with proliferativediabetic retinopathy.
Methods: The levels of $DF-1 and VEGF in the vitreous of 30 eyes of 30 patients withproliferative diabetic retinopathy(PDR)and 12 eyes of 12 patients with idiopathicmacular hole (MH) were measured by enzyme-linked immunosorbent assay. Vitreousfluid samples were obtained by vitrectomy.
Resuls: The vitreous concentration of VEGF was signifcantly higher in eyes with PDR(2 865.87+387.85 pg/ml) than in eyes with idiopathic macular hole (142.42+21.03 Pgml, P< 0.000 1). The vitreous level of SDF-1 was also significantly higher in eyes withPDR (298.40+24.57 pg/ml ) than in eyes with idiopathic macular hole (86.91+15.89Pg/ml, P<0.000 1 ). The vitreous concentration of SDF-1 correlated significantly with that of VEGF in eyes with PDR( [correlation coefficient]r=0.62,P<0 .001)
Conclution: Vitreous levels of both SDF-1 and VEGF in patients with PDR aresignificantly higher than those of nondiabetic patients. SDF-1 may be correlated withVEGF in angiogenesis in PDR.

目的：评价欧堡Daytona 200度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法：本研究为前瞻性病例研究，收集爱尔眼科医院要求行屈光手术的近视患者1 000例(2 000只眼)，分别进行小瞳下欧堡Daytona 200度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查，记录检查结果并进行比较分析。结果：通过欧堡Daytona 200度超广角激光扫描检眼镜检查发现有周边视网膜病变共230例(310只眼)，检出阳性率为15.50%；三面镜检查发现周边部视网膜病变共242例(322只眼)，检出阳性率为16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性(Kappa值0.8~1.0)。结论：欧堡Daytona 200度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法，在屈光手术前筛查视网膜周边部病变，具有广阔的临床应用前景。

Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by three- mirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery.

患者女，60岁，因“右眼前黑影飘动1月，视力下降8天”就诊。视力：右眼0.1，不能矫正；左眼0.6矫正0.9。右眼眼底见视盘周围边界清晰不规则灰白色区，并波及中心凹。视野检查：右眼对应眼底病灶的视野缺损；左眼正常。光学相干断层成像术(optical coherence tomography，OCT)显示灰白色区域椭圆体带不规则、缺失，视网膜色素上皮(retinal pigment epithelium，RPE)层见数个指状隆起。眼底自发荧光(autofluorescence，AF)示：受影响区域内呈高荧光和部分不规则低荧光区。荧光素眼底血管造影(fundus fluorescein angiography，FFA)示：早期见荧光渗漏，晚期荧光着染、蓄积。吲哚菁绿血管造影(indocyanine green angiography，ICGA)示：见以视乳头为中心，边界清晰的低荧光区。诊断：右眼急性轮状外层视网膜病变。治疗：给予抗炎和改善血循环4周，眼底灰白色环状带消失，视力明显好转。随访6个月，患者病情控制良好。

A 60-year-old woman was admitted to Chengdu Aidi Eye Hospital because of “dark shadow fluttering in the right eye for 1 month and vision loss for 8 days”. Visual acuity—with a myopic correction—was 0.1 with the right eye and 0.9 with the left eye. The right eye fundus presented a well-defined, irregular, grayish white area around the optic disc, and affected the fovea, corresponding to the visual field defect of the fundus lesion. Optical coherence tomography (OCT) showed that the ellipsoid bands in this region were irregular and absent, and several finger-like ridges were seen in the retinal pigment epithelium (RPE) layer. Fundus autofluorescence (AF): High fluorescence and some irregular low fluorescence in the affected area. Fundus fluorescein angiography (FFA): Fluorescence leakage was seen in the early stage, fluorescence staining and accumulation in the late stage. Indocyanine green angiography (ICGA): A well-defined low-fluorescence area centered on the optic nipple was observed. Diagnosis:Acute annular outer retinopathy. Treatment: Anti-inflammatory and improved blood circulation for 4 weeks, the gray and white ring of fundus disappeared and the visual acuity improved obviously

目的：评价欧堡Daytona 200度超广角激光扫描检眼镜检查近视患者眼底周边部视网膜病变的应用价值。方法：本研究为前瞻性病例研究，收集爱尔眼科医院要求行屈光手术的近视患者1 000例(2 000只眼)，分别进行小瞳下欧堡Daytona 200度超广角激光扫描检眼镜眼底检查和散瞳后三面镜检查，记录检查结果并进行比较分析。结果：通过欧堡Daytona 200度超广角激光扫描检眼镜检查发现有周边视网膜病变共230例(310只眼)，检出阳性率为15.50%；三面镜检查发现周边部视网膜病变共242例(322只眼)，检出阳性率为16.10%。两种检查方法对近视患者周边部视网膜病变检出阳性率具有很好的一致性(Kappa值0.8~1.0)。结论：欧堡Daytona 200度超广角成像系统为检查周边部视网膜病变提供了更省时高效的方法，在屈光手术前筛查视网膜周边部病变，具有广阔的临床应用前景。

Objectives: To evaluate the clinical value of peripheral retinal diseases in myopic patients examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona). Methods: This was a prospective case-control study. We collected 1 000 myopic patients (2 000 eyes) who were scheduled to undergo refractive surgery in Aier Eye Hospital. They were examined by 200-degree ultra-wide field laser ophthalmoscope (Daytona) with non-mydriasis and three-mirror contact lens with mydriasis. The examination results were recorded and statistically analyzed. Results: A total of 230 cases (310 eyes) with peripheral retinopathy were found by 200-degree ultra-wide field laser ophthalmoscope (Daytona). The positive rate was 15.50%; 242 cases (322 eyes) with peripheral retinopathy were found by three- mirror contact lens, and the positive rate was 16.10%. The two methods were consistent in the detection of peripheral Retinopathy in myopic patients (the Kappa value is between 0.8 and 1.0). Conclusion: 200-degree ultra-wide field laser ophthalmoscope (Daytona) is an effective and rapid method for detecting peripheral retinopathy. It provides a broad clinical application prospects for peripheral retinopathy screening before refractive surgery.

目的：观察视网膜激光光凝术(laser photocoagulation，LP)及玻璃体腔注射雷珠单抗(intravitreal ranibizumab，IVR)对病变位于II区的阈值前病变1型早产儿视网膜病变(retinopathy of prematurity，ROP)的疗效。方法：收集2015年10月至2019年12月厦门市儿童医院收治的病变位于II区的阈值前病变1型44例(81眼)。根据手术方式分为LP组、IVR组。观察各组术后病变消退、视网膜血管化情况、全身及眼部并发症，分析不同手术方式的效果。结果：LP组20例(37只眼)行视网膜激光光凝治疗，术后未出现复发，首次治愈率100%；术后(3.42±1.57)周病情控制，术后(9.84±4.75)周可观察到周边视网膜血管化。IVR组24例(44只眼)注射雷珠单抗，39只眼行单次手术后病情控制，首次治愈率88.6%，5眼术后病情未控制。术后(2.95±2.58)周病情控制，术后(14.19±4.95)周可观察到周边视网膜血管化。两组手术方式首次治愈率、视网膜血管化时间差异有统计学意义(P<0.05)。结论：视网膜LP及IVR治疗病变位于II区的阈值前病变1型均有较好疗效，IVR复发率较高，手术方式的选择需慎重。

Objective: To observe the efficacy of laser photocoagulation (LP) and intravitreal ranibizumab (IVR) injection in the treatment of type 1 prethreshold retinopathy of prematurity (ROP) with lesions located in zone II. Methods:Forty-four patients (81 eyes) with type 1 prethreshold retinopathy of prematurity with lesions located in zone II staying in our hospital from October 2015 to December 2019 were collected and divided into LP group and IVR group according to the operation method. Through observation of the postoperative disease involution, retinal vascularization, systemic and ocular complications in each group, the effects of different surgical methods were analyzed. Results: In LP group, 20 patients (37 eyes) underwent retinal laser photocoagulation treatment, with no recurrence occurred after the operation; the cure rate after the first operation was 100%; the disease was controlled at (3.42±1.57) weeks after the operation; and peripheral retinal vascularization was observed at (9.84±4.75) weeks after the operation. In IVR group, 24 patients (44 eyes) were injected with ranibizumab; 39 eyes were under control after a single operation; the cure rate after the first operation was 88.6%; and 5 eyes were not under control after surgery. The disease was controlled for an average of (2.95±2.58) weeks after operation; peripheral retinal vascularization was observed at (14.19±4.95) weeks after operation; there were statistically significant differences in the cure rate after the first operation and retinal vascularization time between the two groups. Conclusion:Retinal laser photocoagulation and IVR have good effects in the treatment of type 1 prethreshold retinopathy of prematurity with lesions located in zone II. However, the recurrence rate using IVR is relatively high. Therefore,the surgical method needs to be cautious and still requires clinical observation.

目的：分析湖南地区汉族人群中2型糖尿病患者的人口学特征及生化指标，寻找糖尿病视网膜病变的高危因素。方法：釆用病例对照研究，统计湖南地区正常人群、2型糖尿病但无视网膜病变患者、2型糖尿病视网膜病变患者的人口学特征及生化指标的相关数据，进行成组t检验及logistic回归分析，探讨分析糖尿病视网膜病发生的易感因素。所有研究对象均为汉族。结果：对照组[非糖尿病(non-diabetes mellitus，NDM)组]和2型糖尿病未合并视网膜病变[(non-diabetic retinopathy，NDR)]组之间性别分布、年龄分布、BMI、舒张压、HbA1c、总胆固醇、高密度脂蛋白(high-density lipoprotein，HDL)、尿酸及总胆红素差异无统计学意义(均P>0.05)。NDM组中腹围、收缩压、空腹血糖、三酰甘油、肌酐和低密度脂蛋白(low-density lipoprotein，LDL)值均低于NDR组，差异有统计学意义(均P<0.05)。NDM组中BMI、腹围、收缩压、舒张压、空腹血糖、HbA1c、总胆固醇、三酰甘油、肌酐和LDL值均低于2型糖尿病合并视网膜病变组(diabetic retinopathy，DR)组，差异有统计学意义(均P<0.05)。NDR组收缩压、舒张压、HbA1c、总胆固醇、三酰甘油和肌酐值均低于DR组，差异有统计学意义(均P<0.05)。结论：收缩压超过150 mmHg，舒张压超过90mmHg，糖化血红蛋白超过9%，血清肌酐超过100 μmol/L，三酰甘油超过3 mmol/L均为糖尿病患者发生视网膜病变的高危易感因素。

Objective: To analyze the demographic characteristics and biochemical indexes of type 2 diabetic patients in Han population in Hunan, and to find the high-risk factors of diabetic retinopathy. Methods: The data of demographic characteristics and biochemical indexes of normal population, type 2 diabetic patients but without retinopathy and type 2 diabetic retinopathy in Hunan were analyzed. Group t test and logistic regression analysis were used to analyze the susceptibility factors of diabetic retinopathy. All the subjects were Han population. Results: There were no significant differences in gender distribution, age distribution, BMI, diastolic blood pressure, HbA1c,total cholesterol, high-density lipoprotein, uric acid and total bilirubin between the control group [non-diabetes mellitus (NDM) group] and the type 2 diabetic without retinopathy group [non-diabetic retinopathy (NDR)group] (all P>0.05). The abdominal circumference, systolic blood pressure, fasting blood glucose, triglyceride,creatinine and low-density lipoprotein in NDM group were all lower than those in NDR group, and the differences were statistically significant (all P<0.05). BMI, abdominal circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, total cholesterol, triglyceride, creatinine and LDL in NDM group were all lower than those in type 2 diabetic retinopathy (DR) group, and the differences were statistically significant (all P<0.05). The comparison between the NDR group and the DR group showed that the values of systolic blood pressure,diastolic blood pressure, HbA1c, total cholesterol, triglyceride and creatinine in the NDR group were all lower than those in the DR group, and the differences were statistically significant (all P<0.05). Conclusion: SBP ≥150 mmHg,DBP ≥90 mmHg, HbA1c ≥9%, serum creatinine ≥100 μmol/L, triglyceride ≥3 mmol/L are the high-risk factors of diabetic retinopathy.

Purtscher样视网膜病变是一种少见的视网膜血管性疾病，该文分析了13例Purtscher样视网膜病变的临床特征。典型的眼底表现包括 Purtscher斑22眼、棉絮斑22眼、视网膜出血13眼、黄斑水肿22眼、视盘水肿12眼和假樱桃红斑10眼。荧光素血管造影异常表现包括毛细血管无灌注区21眼，毛细血管前闭塞22眼。13例患者中有9例使用糖皮质激素、免疫抑制剂，4例使用改善循环、营养神经等治疗。随访2周至5年，4例患者(6眼)在随访期间出现神经上皮萎缩并持续低矫正视力(<0.1)。基于文献回顾，讨论了Purtscher样视网膜视力恢复不佳可能与黄斑水肿及无灌注区形成有关。

Purtscher-like retinopathy is a rare retinal vascular disease. In this study,the clinical characteristics of 13 cases of Purtscher-like retinopathy were analyzed. Typical fundus abnormalities included Purtscher flecken (22 eyes), cotton-wool spots (22 eyes), retinal hemorrhages (13 eyes), macular edema (22 eyes), swelling of optic disk (12 eyes), and falsecherry red spots (10 eyes). The abnomal manifestations of fluorescein angiography included non perfusion area of capillaries (21 eyes), and precapillary occlusion (22 eyes). Among 13 patients, 9 patients were treated with glucocorticoids and immunosuppressive drugs, and 4 patients were treated with circulation-improving and neurotrophic drugs. During the follow-up period of two months to five years, four patients (six eyes) experienced neuroepithelial atrophy and persistent low vision (<0.1). Based on literature review, we proposed that the prognosis of vision in Purtscher-like retinopathy may be associated with macular edema and the formation of capillary non-perfusion.

目的：分析不同程度2型糖尿病视网膜病变的血清生化全套指标，探讨各生化指标与糖尿病性视网膜病变(diabetic retinopathy，DR)程度的相关性。方法：回顾性收集2018年5月至2020年10月在福建医科大学附属第二医院就诊的2型糖尿病患者。根据眼底情况分为3组：糖尿病不伴视网膜病变(non-diabetic retinopathy，NDR)组(17例)、糖尿病伴非增殖性视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(29例)、糖尿病伴增殖期视网膜病变(proliferative diabetic retinopathy，PDR)组(34例)。采用SPSS 24.0分析比较3组血清生化全套各指标水平，对差异指标与DR相关性采用Pearson相关分析与多重线性回归分析。结果：3组年龄差异无统计学意义(P>0.05)；3组的总蛋白、白蛋白、白球比、钙浓度差异均有统计学意义(均P<0.05)。组间比较发现NPDR和PDR组总蛋白、白蛋白、白球比、钙浓度低于NDR组，差异有统计学意义(P<0.05)。Pearson相关分析显示总蛋白(r=?0.290)、白蛋白(r=?0.304)，钙浓度(r=?0.252)与DR呈负相关(均P<0.05)，多重线性回归提示总蛋白、白蛋白及血钙浓度是DR保护因素(P<0.05)。结论：血清指标总蛋白、白蛋白及血钙浓度与DR成负相关，在生理范围内将这些指标维持相对较高的水平，或许可以为糖尿病视网膜病变的防治提供新思路。

Objective: To analyze the serum biochemical indexes of different degrees of type 2 diabetic retinopathy, and the correlation between biochemical indexes and the degree of diabetic retinopathy (DR). Methods: Patients with type 2 diabetes admitted to the Fujian Medical University 2nd Affiliate Hospital from May 2018 to October 2020 were retrospectively collected. The patients were divided into 3 groups according to fundus conditions: non-diabetic retinopathy (NDR) group (n=17), diabetes with non-proliferative diabetic retinopathy (NPDR) group (n=29),diabetes with proliferative diabetic retinopathy (PDR) group (n=34). SPSS 24.0 was used to compare the levels of a complete set of serum biochemical indexes in the three groups. Pearson correlation analysis and multiple linear regression analysis were used for the correlation between the different indexes and DR. Results: There was no statistically significant difference in age between the three groups. The differences in total protein, albumin, white sphere ratio, and calcium concentration of the three groups were statistically significant (P<0.05). The comparison between the groups showed that the total protein, albumin, white sphere ratio, and calcium concentration in the NPDR and PDR groups were lower than those in the NDR group. The difference was statistically significant (P<0.05). Pearson correlation analysis showed that total protein (r=?0.290), albumin (r=?0.304), and

calcium concentration (r=?0.252) were negatively correlated with DR (all P<0.05). Multiple linear regression indicated total protein, albumin and blood calcium concentration were the protective factors of DR (P<0.05).Conclusion: This study found that serum levels of total protein, albumin, and blood calcium levels are negatively correlated with DR. Maintaining a relatively high level of these indexes within the physiological range may provide new ideas for the prevention and treatment of diabetic retinopathy.