糖尿病视网膜病变的管理:一个系统的审查
Quresh Mohamed1, Mark C Gillies, Tien Y Wong
1Centre for Eye Research Australia, University of Melbourne and Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
JAMA
|August 23, 2007
概括
糖尿病视网膜病变 (DR) 管理依赖于严格的血糖和血压控制以预防. 激光光凝疗有效地减少严重DR和黄斑的视力损失,但其他治疗方法的证据仍然有限.
科学领域:
- 眼科医生 眼科 眼科
- 内分泌学 在内分泌学.
- 基于证据的医学是基于证据的医学.
背景情况:
- 糖尿病视网膜病变 (DR) 是工作年龄成人失明的主要原因.
- 关于许多新的DR干预措施的有效性存在不确定性.
研究的目的:
- 系统地审查糖尿病视网膜病变 (DR) 管理中的初级和二级干预措施的最佳可用证据.
- 为了评估糖尿病黄斑胀的干预措施.
主要方法:
- 从1966年到2007年5月,对英语文章进行了系统审查,包括随机对照试验 (RCT) 和元分析.
- 搜索了多个数据库 (MEDLINE,EMBASE,Cochrane) 和参考列表.
- 应用Delphi共识标准来识别进行良好研究.
主要成果:
- 严格的血糖和血压控制显著降低了DR的发生率和进展.
- 泛视网膜激光光凝血将严重/增殖性视网膜病变中视力损失的风险减半.
- 焦点激光光凝视疗法在黄斑的病例中,可以减少50-70%的中度视力损失.
- 早期玻璃切除术改善了玻璃体出血的增殖性视网膜病变中的视觉恢复.
- 没有足够的证据表明,在DR中,降脂疗法,医疗干预或抗VEGF药物存在.
结论:
- 最佳的血糖和血压控制对于初级DR预防至关重要.
- 激光光凝 (泛视网膜和焦点) 是有效的严重的DR和黄斑,分别.
- 由于证据不足,目前不建议常规使用其他DR治疗方法.
相关概念视频
Diabetes Mellitus: Overview and Type I Subtype
5.5K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
5.5K
Diabetes: Symptoms, Diagnosis, and Complications
2.5K
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
2.5K
Diabetes: Management and Pharmacotherapy
1.5K
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
1.5K
Nephrotic Syndrome II : Assessment and Medical Management
409
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
409
Diabetic Retinopathy
55
DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
55
Diabetic Nephropathy
32
Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration...
32


