Pearce I A, Ilango B, Sells R A, Wong D
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP.
Br J Ophthalmol. 2000 Jul;84(7):736-40. doi: 10.1136/bjo.84.7.736.
BACKGROUND/AIMS: Simultaneous pancreas and kidney transplantation (SPK) has become an important option in selected IDDM patients with end stage renal disease (ESRD). Successful SPK transplants are associated with long term normoglycaemic control and improved quality of life. However, debate still continues on the benefit to patients in terms of stabilisation or amelioration of diabetic retinopathy. The progression of diabetic retinopathy (DR) in a cohort of 20 SPK transplant patients is reported.
All patients were reviewed postoperatively with corrected visual acuity, slit lamp examination, and fundal biomicroscopy. Preoperative data were collected retrospectively and DR was considered unstable if there had been a drop in Snellen acuity greater than three lines or a need for laser photocoagulation or vitrectomy in the 2 years preoperatively.
20 patients who received SPK transplants between March 1983 and April 1994 were reviewed (mean age 35.1 years; mean duration of IDDM = 24.6 years). 17 patients still had functioning grafts at a mean follow up of 5.1 years. Nine of these patients had unstable DR before transplantation. Of these, 89% (8/9) had stabilised DR following transplantation with only a single case requiring laser photocoagulation. Of the eight patients that had stable DR before transplantation all had stable DR following transplantation. 41% of cases (7/17) required cataract surgery during the follow up period.
Advanced diabetic retinopathy is present in a high proportion of cases managed with SPK transplant as a consequence of the duration of IDDM and the presence of ESRD. More than 90% of cases have stable DR following transplant.
背景/目的：胰肾联合移植（SPK）已成为特定终末期肾病（ESRD）的胰岛素依赖型糖尿病（IDDM）患者的重要治疗选择。成功的SPK移植与长期血糖正常控制及生活质量改善相关。然而，关于其对糖尿病视网膜病变的稳定或改善作用仍存在争议。本文报告了一组20例SPK移植患者糖尿病视网膜病变（DR）的进展情况。
所有患者术后均接受了视力矫正、裂隙灯检查和眼底生物显微镜检查。术前数据进行回顾性收集，若术前2年内Snellen视力下降超过3行，或需要进行激光光凝或玻璃体切除术，则认为DR不稳定。
对1983年3月至1994年4月间接受SPK移植的20例患者进行了回顾性研究（平均年龄35.1岁；IDDM平均病程24.6年）。17例患者在平均随访5.1年时移植肾仍有功能。其中9例患者移植前DR不稳定。其中，89%（8/9）的患者移植后DR病情稳定，仅1例需要进行激光光凝。移植前DR病情稳定的8例患者移植后DR均保持稳定。41%（7/17）的病例在随访期间需要进行白内障手术。
由于IDDM病程及ESRD的存在，接受SPK移植治疗的患者中晚期糖尿病视网膜病变比例较高。超过90%的病例移植后DR病情稳定。
