3.4 DR与视网膜动静脉阻塞
Brahim等[32]报道1例55岁男性DR患者,一眼出现视网膜中央动脉阻塞,3a后该眼未发现DR进展,而对侧眼却出现DR进展现象。视网膜中央动脉阻塞后DR进展减少的机制可能是视网膜内层萎缩和因视网膜血流降低所致。Bursell等[33]发现早期视网膜中央动脉血流速度加快与高血糖代谢异常有关,可能是视网膜血管的自动调节作用。这种早期视网膜的高灌注状态可能是诱发或加重DR发生、发展的危险因素之一。
3.5 DR与视神经病变[34]
中村诚等[35]对合并单眼视神经萎缩的DR 9例18眼进行研究。视神经萎缩原因为:外伤性1例,前部缺血性视神经病变4例,不明原因4例。结果是:明显视神经萎缩,具广泛视野缺损5例,其视神经萎缩眼的视网膜症较对侧眼轻,考虑萎缩对视网膜症有抑制效果。轻度萎缩的4例两眼视网膜症无明显差别,因此萎缩要达到抑制视网膜症发展,则其视野障碍应占1/4象限以上,即视野损害必须是严重的。
4结语 愈来愈多的迹象表明控制全身因素如血糖、血压和血脂对DR的治疗是很重要的。我们要让患者了解这些知识,即严格控制血糖和血压、纠正脂代谢紊乱从而减少和延缓糖尿病并发症的发生和发展,减少视力的丧失。通常两眼视网膜病变程度大致相同,但由于眼局部的某些因素的影响而使两眼间的视网膜病变产生明显差异,因此,对于DR发生发展相关的眼局部因素的研究,有助于进一步加深对DR发生发展的认识,并且为DR的治疗提供了新的思路和发展的方向。
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