Dibble C M, Kochenour N K, Worley R J, Tyler F H, Swartz M
Obstet Gynecol. 1982 Jun;59(6):699-704.
The incidence of progression of diabetic retinopathy during pregnancy is unknown and its proper management uncertain. In this study, 55 insulin-dependent diabetic patients under strict glucose control were followed throughout pregnancy with serial retinal examinations by ophthalmoscopy and photographs. Nineteen patients had minimal or background retinopathy and 7 had untreated proliferative changes. Six patients had been treated before pregnancy with photocoagulation for proliferative retinopathy. A positive correlation was found between progressive proliferative diabetic retinopathy and the duration of diabetes mellitus independent of glucose control. During gestation 3 of 19 patients (16%) with minimal or background retinopathy and 6 of 7 patients (86%) with untreated proliferative retinopathy experienced deterioration of their eye disease. In 4 patients with proliferative retinopathy, progression of retinal disease was arrested with photocoagulation during pregnancy. Only 1 of 6 who had received laser treatment prior to pregnancy experienced progression of her retinopathy. These results suggest that photocoagulation prior to pregnancy may protect against rapidly progressive proliferative retinopathy and that aggressive treatment during pregnancy can prevent progression of proliferative retinopathy and visual impairment.
糖尿病视网膜病变在孕期进展的发生率尚不清楚，其恰当的治疗方法也不确定。在本研究中，对55例严格控制血糖的胰岛素依赖型糖尿病患者在整个孕期进行了随访，通过检眼镜检查和拍照进行系列视网膜检查。19例患者有轻度或背景性视网膜病变，7例有未经治疗的增殖性病变。6例患者在妊娠前因增殖性视网膜病变接受过光凝治疗。发现进展性增殖性糖尿病视网膜病变与糖尿病病程呈正相关，与血糖控制无关。在妊娠期，19例有轻度或背景性视网膜病变的患者中有3例（16%）、7例未经治疗的增殖性视网膜病变患者中有6例（86%）眼部疾病恶化。在4例增殖性视网膜病变患者中，孕期通过光凝治疗阻止了视网膜疾病的进展。妊娠前接受过激光治疗的6例患者中只有1例视网膜病变进展。这些结果表明，妊娠前进行光凝治疗可能预防快速进展的增殖性视网膜病变，孕期积极治疗可防止增殖性视网膜病变进展和视力损害。
