L'Esperance F A
Med Clin North Am. 1978 Jul;62(4):767-85.
The only methods of treatment for severe diabetic retinopathy that have been proved effective by controlled clinical trials are photocoagulation and pituitary ablation. It must be noted that photocoagulation and pituitary ablation impede but do not cure diabetic retinopathy. Pars plana vitrectomy can be highly effective for removing blood from the vitreous of the eye, allowing better vision, particularly if the retina has been shown to be functional by electrophysiologic testing and ultrasonography. In addition, vitrectomy allows the ophthalmologist to visualize, evaluate, and treat the diabetic retina by photocoagulation or other methods. Attempts at better regulation of blood sugar have reduced the development of microangiopathy in experimental animals and recently in man. The benefits of rigorous regulation of the blood sugar has been noted in a policy statement by the American Diabetes Association. The development of a practical, beneficial pancreas has been undertaken, and may be required in order to reap the full benefits of rigorous blood sugar control. It has been recommended that all patients be evaluated by an ophthalmologist as soon as they have been found to have diabetes, that all diabetics be examined ophthalmologically on an annual basis, and that patients with significant retinopathy be seen at 6 month or shorter intervals by their ophthalmologist. The evaluation and treatment of diabetic retinopathy has progressed enormously during the past decade. It is hoped that the cause of diabetic microangiopathy and retinopathy will be discovered in the near future so that treatment will ultimately cure rather than control the process of diabetic retinopathy.
经对照临床试验证明有效的重度糖尿病视网膜病变的唯一治疗方法是光凝法和垂体切除术。必须指出的是，光凝法和垂体切除术会阻碍但无法治愈糖尿病视网膜病变。玻璃体切割术对于清除眼内玻璃体中的血液非常有效，能改善视力，特别是在视网膜经电生理测试和超声检查显示仍有功能时。此外，玻璃体切割术使眼科医生能够通过光凝法或其他方法观察、评估和治疗糖尿病视网膜。在实验动物以及最近在人类中，更好地控制血糖的尝试减少了微血管病变的发生。美国糖尿病协会的一份政策声明中提到了严格控制血糖的益处。目前正在研发一种实用且有益的胰腺，可能需要这样做才能充分获得严格控制血糖的全部益处。建议所有被诊断出患有糖尿病的患者尽快由眼科医生进行评估，所有糖尿病患者每年进行眼科检查，患有严重视网膜病变的患者应由眼科医生每6个月或更短时间进行一次检查。在过去十年中，糖尿病视网膜病变的评估和治疗取得了巨大进展。希望在不久的将来能发现糖尿病微血管病变和视网膜病变的病因，以便最终能治愈而非仅仅控制糖尿病视网膜病变的进程。
