| Diabetes mellitus (DM) is one of the major diseases in China. The World Health Organization has estimated that by the year2011there will be366million persons affected with DM,92.4million adult in china, which rank first in the world. It is one of the leading causes of blindness in the30-74years age group. Proliferative diabetic retinopathy (PDR) is one of the severe microvascular complications of diabetes, and the main cause of diabetic blindness with low cure rate, high blinding rate and irreversibility, so the prevention and treatment of PDR is very important, but it need three steps. First, how to prevent its occurrence? Secondly, how to inhibit the progress? Thirdly how to treat the proliferative diabetic retinopathy timely and effectively, to prevent visual impairment and blindness. Therefore, based on the issue list above this research include three part.Part One. The risk factor of proliferative diabetic retinopathy in type2diabetes:a case control study ObjectiveTo study the risk factors in type2diabetic patients in guangdong province.MethodsThe study was based on a retrospective case-control study. The clinical data of300patients with diabetes mellitus were analyzed, which were divided into three groups, non-diabetic, retinopathy group, non proliferative retinopathy group, proliferative diabetic retinopathy group according to their fundus. All of patients were born in guangdong and grew up in guangdong. There were143male (47.7%) and157female (52.3%) patients, median age68.5(45-75) years, duration of diabetes9.84(1-28) years. Data were collected on age, gender, diabetes duration, blood pressure, blood glucose, lipid, urinary albumin excretion, diabetic retinopathy, diabetic neuropathy,and so on.Results1. The patients of PDR group differed statistically significantly from the other group according to the following variables:longer duration, high systolic blood pressure, high HbAlc, high triglyceride.higher low density lipoprotein cholesterol, high creatinine, high blood urea nitrogen, high lower creatinine clearance rate and lower c peptide (P<0.05). However there weren’t statistically significant about diastolic blood pressure, total cholesterol and high density lipoproteincholesterol(P>0.05).2. There was more frequent diabetic complications including nephropathy and peripheral neuropathy in PDR group. The difference was statistically significant by Chi-Square test.ConclusionThere is a positive correlation between duration of disease, HbAlc, triglyceride, low density lipoprotein cholesterol and PDR. while there is a negative correlation between creatinine clearance rate, fast c peptide and PDR. PDR may be closely associated with diabetic nephropathy, peripheral neuropathy in guangdong province.Part Two. Characteristics of traditional chinese medcine syndrome of proliferative diabetic retinopathyObjectiveTo study the characteristics of traditional chinese syndromes of proliferative diabetic retinopathy in type2diabetic patients in guangdong province.MethodsThe study was based on a retrospective case-control study. The clinical data of300patients with diabetes mellitus were analyzed, which were divided into three groups, non-diabetic, retinopathy group, non proliferative retinopathy group, proliferative diabetic retinopathy group according to their fundus. All of patients were born in guangdong and grew up in guangdong. The information of Chinese medical law was collected, then the database was established and analysised by PASW Statistics18.0software. Results1. In the non-diabetic, retinopathy group the common syndroms was Yin deficiency, Heat, Blood stasis. In the non proliferative retinopathy group it was Yin deficiency, Qi deficiency, Blood stasis. In the proliferative retinopathy group the it was Yin deficiency, Qi deficiency, Phlegm dampness.2. The syndrome of deficiency of both Qi and Yin, phlegm and blood stasis was the most common in proliferative diabetic retinopathy in guangdong province, which was statistically significant by Chi-Square test(P<0.05).3. There was no link between age, sex and the syndrome of deficiency of both Qi and Yin, phlegm and blood stasis in PDR patients.4. There was a correlation between fundus and the syndrome of deficiency of both Qi and Yin, phlegm and blood stasis in PDR patients, which was the most common syndrome when the PDR patients’s fundus appeared the proliferative membrane, tractional retinal detachment.ConclusionsDeficiency-excess complication and muti card combination is the characteristics of proliferative diabetic retinopathy. The pathogenesis of DR is the deficiency in origin, early in the course of the disease is given priority to with Yin deficiency, followed by Qi deficiency, Yang deficiency finally. The excess in superficiality actually coincides with progression, Heat first appeared, followed by Blood stasis and Phlegmy dampness. The most common syndrome was the pattern of deficiency of both Qi and Yin, phlegm and blood stasis in proliferative diabetic retinopathy, expecially when the patients’s fundus appeared the proliferative membrane, tractional retinal detachment.Part Three. Optimization treatment of proliferative diabetic retinopathyObjectiveTo compare the efficacy between retinal photocoagulationand combination treatment (intravitreal bevacizumab and retinal photocoagulation) for the treatment of proliferative diabetic retinopathy.MethodsIn this prospective study we investigated60patients(113eyes) of proliferative diabetic retinopathy, in which30patients(55eyes) with the combination treatment of intravitreal Avastin and retinal photocoagulatiocombination and30patients(58eyes) with retinal photocoagulation. All of patients were reviewed until3-9months (average6.3months)after treatment. The present study compared changes of visual acuity (VA),retinal neovascularization, macular thickness and the incidence of vitreous hemorrhage again at each follow up by FFA and OCT.ResultsIn the combination treatment, the mean±SEM logarithm of minimum angle of resolution best-corrected visual acuity improved from0.61±0.43at baseline to0.35±0.36at Week12(P<0.05). In the retinal photocoagulation only, BCVA improved from0.56±0.43to0.46±0.19. There was significant improvement of BCVA at the final follow-up with either treatment, but the effect of combination treatment is better than photocoagulation only, which has statistically significant. At the12-week follow-up visit,67.3%of the combination treated eyes showed complete regression of retinal new vessels, while only43.1%of the photocoagulation treated eyes appeared that phenomenon. There was no adverse reaction in the combination treatment.ConclusionsThe effect of intravitreal Avastin and retinal photocoagulation is better than retinal photocoagulation, with a significantly improvement in BCVA, retinal new vessels and central macular thickness. |
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