Cunha-Vaz J G
Department of Ophthalmology, University of Coimbra, Portugal.
Diabetes. 1983 May;32 Suppl 2:20-7. doi: 10.2337/diab.32.2.s20.
A review of the pathologic picture of diabetic retinopathy shows that available clinical methods of examination demonstrate the alteration of the blood-retinal barrier (leakage), microaneurysms, capillary closure, preferential channels, preretinal neovascularization and gross extravascular lesions. All of these changes may be shown by fluorescein angiography. The value of this method, however, is fundamentally related to the morphologic demonstration of these lesions and not their quantification. Quantitative evaluation of retinal involvement in diabetes is needed in order to delineate more clearly its natural history, criteria for prognosis, and effect of treatment. Vitreous fluorophotometry, a quantitative and sensitive method of evaluating the permeability of the blood-retinal barrier, has opened new perspectives for the evaluation of retinal involvement in diabetes. Vitreous fluorophotometry has shown that a disturbance of the blood-retinal barrier, possibly functional, appears in diabetic eyes before any lesion is clinically visible in the fundus, and that there is a close correlation between the severity of the vascular lesions and higher vitreous fluorophotometry readings. Recent studies also indicate an interesting correlation with metabolic control, particularly, glycosylated hemoglobin levels and insulin treatment. Finally, on the basis of these findings a working hypothesis for the pathogenesis of diabetic retinopathy is presented.
对糖尿病视网膜病变病理图像的回顾显示，现有的临床检查方法可证实血视网膜屏障的改变（渗漏）、微动脉瘤、毛细血管闭塞、优先通道、视网膜前新生血管形成以及明显的血管外病变。所有这些变化均可通过荧光素血管造影显示。然而，该方法的价值从根本上与这些病变的形态学显示有关，而非其定量分析。为了更清楚地描绘糖尿病视网膜病变的自然病程、预后标准及治疗效果，需要对糖尿病视网膜受累情况进行定量评估。玻璃体荧光光度测定法是一种评估血视网膜屏障通透性的定量且敏感的方法，为评估糖尿病视网膜受累情况开辟了新的视角。玻璃体荧光光度测定法表明，在眼底临床可见任何病变之前，糖尿病患者的眼睛就可能出现血视网膜屏障的功能紊乱，且血管病变的严重程度与较高的玻璃体荧光光度测定读数之间存在密切关联。近期研究还表明，其与代谢控制存在有趣的相关性，尤其是糖化血红蛋白水平和胰岛素治疗。最后，基于这些发现提出了糖尿病视网膜病变发病机制的一个工作假说。
