Brinchmann-Hansen O, Dahl-Jørgensen K, Hanssen K F, Sandvik L
Department of Ophthalmology, Trondheim University Hospital, Norway.
Acta Ophthalmol (Copenh). 1992 Apr;70(2):235-42. doi: 10.1111/j.1755-3768.1992.tb04130.x.
Effects of long-term improved glucose control on neurosensory retinal function are investigated. Changes in macular recovery of nyctometry (photostress) are assessed in 45 insulin-dependent diabetic patients between study start and after 7 years prospective follow-up (the Oslo Study). Intensified insulin treatment improved glycosylated hemoglobin (HbA1) from 11.7 +/- 2.2% at start to a 7-year cumulative mean of 9.5 +/- 1.5% (p less than 0.0001). Improved macular recovery performance was observed in patients with 7-year mean HbA1 below 10%, compared to a worsening in those above 10% (p less than 0.001-0.02), and non-proliferative retinopathy progressed less in those with HbA1 below 10%, than in those above (p less than 0.01). Macular recovery at study start did not predict progression or outcome of retinopathy 7 years later. Intraocular pressure fell during the 7 years (p less than 0.001) and was cross-sectionally negatively correlated to macular recovery at the 7-year end-point (p less than 0.001-0.002). Macular recovery was not related to age, duration of diabetes, systemic blood pressure, or urinary albumin excretion level. The study indicates that severity of retinopathy, glycemic control and intraocular pressure are interesting covariants to neurosensory dysfunction in diabetes. Furthermore, the study suggests a critical level of long-term blood glucose or retinopathy, or both, above which neurosensory function of macular recovery is significantly reduced.
研究了长期改善血糖控制对视网膜神经感觉功能的影响。在45例胰岛素依赖型糖尿病患者中，评估了研究开始时和7年前瞻性随访后（奥斯陆研究）暗适应测量（光应激）黄斑恢复情况的变化。强化胰岛素治疗使糖化血红蛋白（HbA1）从开始时的11.7±2.2%提高到7年累积平均值9.5±1.5%（p<0.0001）。7年平均HbA1低于10%的患者黄斑恢复表现改善，而高于10%的患者黄斑恢复表现恶化（p<0.001-0.02）；HbA1低于10%的患者非增殖性视网膜病变进展比高于10%的患者少（p<0.01）。研究开始时的黄斑恢复情况不能预测7年后视网膜病变的进展或结局。7年间眼压下降（p<0.001），在7年终点时眼压与黄斑恢复呈横断面负相关（p<0.001-0.002）。黄斑恢复与年龄、糖尿病病程、全身血压或尿白蛋白排泄水平无关。该研究表明，视网膜病变的严重程度、血糖控制和眼压是糖尿病视网膜神经感觉功能障碍的有趣协变量。此外，该研究提示存在一个长期血糖或视网膜病变的临界水平，高于此水平黄斑恢复的神经感觉功能会显著降低。
