Cunha-Vaz J, Leite E, Sousa J C, de Abreu J R
Department of Ophthalmology, University of Coimbra, Portugal.
Graefes Arch Clin Exp Ophthalmol. 1993 Mar;231(3):141-5. doi: 10.1007/BF00920936.
Forty patients with late-onset diabetes (age at diagnosis 30 years or more) and minimal retinopathy as found by fundus photography were followed prospectively by repeated examination (baseline, 1 year, and 4 years). The study shows that early retinopathy changes are not permanent or invariably progressive. In the 1st year of follow-up microaneurysms worsened in 25%, improved in 10%, and remained stabilized in 65%. Vitreous fluorometry was able to detect an overall increase of 0.84 +/- 1.06 x 10(-6) min-1 in blood-retinal barrier (BRB) penetration ratios. After 4 years, 16 of the 40 patients had undergone photocoagulation (focal photo-coagulation in 11 and pan retinal photocoagulation in 5). The eyes that needed photocoagulation were the eyes that had higher fluorometry penetration ratios at the patient's entry into the study and showed a higher rate of deterioration during the 1st year of the study (5.54 +/- 1.97 vs 3.11 +/- 1.22 x 10(-6) min-1, P < 0.001, initial values; 1.52 +/- 0.76 vs 0.45 +/- 0.99 x 10(-6) min-1, P < 0.001, annual increase in leakage). The eyes that did not need photocoagulation, 24 out of 40, showed stable fluorometry readings within the 4-year period of follow-up (+0.02 +/- 0.98 10(-6) min-1). Abnormally high vitreous fluorometry values and their rapid increase over time appear to be good indicators of rapid progression and worsening of the retinopathy.
40例迟发性糖尿病患者（诊断时年龄30岁及以上），经眼底照相发现有轻度视网膜病变，对其进行前瞻性随访，重复检查（基线、1年和4年）。研究表明，早期视网膜病变改变并非永久性的，也并非总是进行性的。在随访的第1年，微动脉瘤恶化的占25%，改善的占10%，稳定的占65%。玻璃体荧光测定法能够检测出血视网膜屏障（BRB）渗透率总体增加0.84±1.06×10⁻⁶ min⁻¹。4年后，40例患者中有16例接受了光凝治疗（11例为局灶性光凝，5例为全视网膜光凝）。需要光凝治疗的眼睛是那些在患者进入研究时荧光测定渗透率较高且在研究第1年恶化率较高的眼睛（初始值：5.54±1.97 vs 3.11±1.22×10⁻⁶ min⁻¹，P<0.001；渗漏年增加量：1.52±0.76 vs 0.45±0.99×10⁻⁶ min⁻¹，P<0.001）。40例中不需要光凝治疗的24只眼睛在4年随访期内荧光测定读数稳定（+0.02±0.98×10⁻⁶ min⁻¹）。玻璃体荧光测定值异常高及其随时间快速增加似乎是视网膜病变快速进展和恶化的良好指标。
