Cataract and retinopathy: Screening for treatable retinopathy

A.J. Bron, H. Cheng
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引用次数: 21

Abstract

Diabetes causes cataract and certain physical changes in the lens. The diabetic lens is larger than the non-diabetic and shows greater light scatter and fluorescence. Both hyperglycaemia and lowering of blood glucose cause refractive changes and hypermetropia is the most common. Classical ‘snow-flake’ juvenile cataract associated with hyperglycaemia is now rare. It has an osmotic mechanism. Diabetes is a risk factor for cataract in adults which is duration dependent, more frequent in women and leads to earlier surgery. It resembles non-diabetic senile cataract. Extracapsular cataract extraction is the method of choice for diabetic cataract with a better visual result and less risk of rubeosis iridis. A posterior chamber implant may still permit retinal photocoagulation if necessary.

Diabetic retinopathy is still the leading cause of blindness in the working age group. The beneficial effect of photocoagulation has been shown by randomized controlled trials to be long-lasting for both proliferative retinopathy and maculopathy. Therefore there is a need for screening, especially for those with proliferative disease which may be present without symptoms. A knowledge of risk factors will enhance detection rate with duration as the strongest determinant for retinopathy.

Any screening modality should be highly sensitive as well as specific. The role of different professionals as potential screeners should be considered.

Adequate provisions include facilities for checking vision and for dimming ambient lighting. Mydriasis and a good ophthalmoscope light will increase detection rate.

The use of a 45° non-mydriatic camera is unlikely to supplant the use of an ophthalmoscope as a single field is likely to miss important lesions.

A 60° camera may confer a large enough field and the use of transparencies will provide magnification when films are projected but the camera is more difficult to use.

A list of features chosen by a recent study to characterize sight-threatening retinopathy is included and their presence indicates the need for referral to an ophthalmic clinic for treatment or close observation.

白内障和视网膜病变:筛查可治疗的视网膜病变
糖尿病会导致白内障和晶状体的某些物理变化。糖尿病晶状体比非糖尿病晶状体大,光散射和荧光更强。高血糖和低血糖都会引起屈光改变,而远视是最常见的。经典的“雪花型”青少年白内障合并高血糖现在是罕见的。它有一个渗透机制。糖尿病是成人白内障的一个危险因素,与病程有关,在女性中更为常见,并导致早期手术。类似于非糖尿病性老年性白内障。白内障囊外摘出术是治疗糖尿病性白内障的首选方法,具有较好的视力效果和较低的虹膜红肿风险。如果需要,后房植入物仍可允许视网膜光凝。糖尿病视网膜病变仍然是工作年龄组失明的主要原因。随机对照试验表明,光凝的有益效果对增殖性视网膜病变和黄斑病变都是持久的。因此,有必要进行筛查,特别是对那些可能没有症状的增生性疾病。了解危险因素将提高检出率,病程是视网膜病变的最强决定因素。任何筛选方式都应具有高度的敏感性和特异性。应考虑不同专业人员作为潜在筛选者的作用。适当的设施包括检查视力和调暗环境照明的设施。散瞳和良好的检眼镜光线会提高检出率。使用45°非散瞳相机不太可能取代检眼镜的使用,因为单一视野很可能错过重要的病变。60°摄像机可以提供足够大的视场,并且在放映胶片时使用透明片可以提供放大倍率,但摄像机使用起来比较困难。最近的一项研究选择了一系列特征来描述视力威胁视网膜病变的特征,这些特征的存在表明需要转诊到眼科诊所进行治疗或密切观察。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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