Ai E
Department of Ophthalmology, California Pacific Medical Center, San Francisco 94120.
West J Med. 1992 Jul;157(1):67-70.
Diabetic retinopathy progresses through three distinct stages. A rational approach to management is based on an understanding of the pathophysiology of each stage. Based on the results of national multicentered clinical trials of laser photocoagulation and other treatments, advances in our understanding of the pathogenesis and treatment can now make a dramatic impact on blindness in the diabetic population: Panretinal laser photocoagulation treatment can reduce the risk of vision loss from high-risk proliferative diabetic retinopathy by at least 50%. Laser photocoagulation treatment of clinically significant diabetic macular edema can reduce the risk of vision loss by more than 50%. Vitrectomy can restore useful vision to some patients with severe diabetic retinopathy and vitreous hemorrhage with or without an accompanying traction retinal detachment. Diabetes 2000 is a new project sponsored by the American Academy of Ophthalmology, the goal of which is to eliminate preventable blindness from diabetes by the year 2000. As its name implies, Diabetes 2000 will be a long-term project aimed at a specific disease--diabetic retinopathy and its complications. It will provide the latest research findings to ophthalmologists and primary care physicians as the first priority, followed by the education of patients and the general public. Recent advances and treatment guidelines for the medical and surgical treatment of diabetic eye disease will be emphasized through the continuing education of ophthalmologists, other physicians, and allied health professionals. In later phases, educational programs for diabetic persons and the public will be developed. Ultimately, improved access of diabetic patients to ophthalmologic care and a close working relationship between ophthalmologists and primary care physicians will ensure early detection of diabetic retinopathy and the timely delivery of state-of-the-art treatments.
糖尿病性视网膜病变分为三个不同阶段。合理的治疗方法基于对每个阶段病理生理学的理解。根据全国多中心激光光凝及其他治疗的临床试验结果，我们对发病机制和治疗的认识取得了进展，现在可以对糖尿病患者的失明情况产生重大影响：全视网膜激光光凝治疗可将高危增殖性糖尿病性视网膜病变导致视力丧失的风险降低至少50%。对临床上有意义的糖尿病性黄斑水肿进行激光光凝治疗可将视力丧失的风险降低50%以上。玻璃体切除术可使一些患有严重糖尿病性视网膜病变和玻璃体出血且伴有或不伴有牵引性视网膜脱离的患者恢复有用视力。“糖尿病2000”是美国眼科学会发起的一个新项目，其目标是到2000年消除可预防的糖尿病性失明。顾名思义，“糖尿病2000”将是一个针对特定疾病——糖尿病性视网膜病变及其并发症的长期项目。它将首先向眼科医生和初级保健医生提供最新研究结果，其次是对患者和公众进行教育。通过对眼科医生、其他医生及相关健康专业人员的继续教育，将重点强调糖尿病眼病药物和手术治疗的最新进展及治疗指南。在后期阶段，将为糖尿病患者和公众制定教育项目。最终，改善糖尿病患者获得眼科护理的机会以及眼科医生与初级保健医生之间密切的合作关系将确保早期发现糖尿病性视网膜病变并及时提供最先进的治疗。
