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1、Wills手册 第十一章 视网膜 第十二节 糖尿病性视网膜病变 郝晓军整理 打杂组11.12 Diabetic Retinopathy第十二节 糖尿病性视网膜病变Diabetic Retinopathy Disease Severity Scale 【糖尿病性视网膜病变分级】 No apparent retinopathy. 1、无显著的视网膜病变。 Mild nonproliferative diabetic retinopathy(NPDR): Microaneurysms only. 2、轻度非增殖型糖尿病性视网膜病变(NPDR)仅有微血管瘤。 Moderate NPDR: More t
2、han mild NPDR, but lessthan severe NPDR. See Figure 11.12.1. 3、中度非增殖型糖尿病视网膜病变(NPDR) 介于轻度和重度非增殖型糖尿病视网膜病变之间。见图。 SevereNPDR: Any of the following in the absence of proliferative diabeticretinopathy: 20 intraretinal hemorrhages in each quadrant, two quadrants ofvenous beading, or one quadrant of promine
3、nt intraretinal microvasclarabnormalities (IRMA). See Figure 11.12.2. 4、重度非增殖型糖尿病视网膜病变(NPDR)无增殖型糖尿病视网膜病变表现，出现以下体征之一:4个象限的视网膜内出血，每一个象限均超过20处，2个象限的静脉串珠样改变，或1个象限的显著的视网膜内微血管异常（IRMA）。见图。 Proliferative diabetic retinopathy (PDR): One or more of:neovascularization (i.e., of the iris, angle, optic disc, or
4、elsewhere), orvitreous/preretinal hemorrhage. See Figures 11.12.3 and11.12.4.5、增殖型糖尿病视网膜病变(PDR) 以下一项或多项：视盘上或距离1个视盘直径的范围内出现新生血管(NVD)，视网膜其他部位出现新生血管(NVE)，虹膜表面出现新生血管(NVI），前房角新生血管(NVA）；玻璃体积血或视网膜前出血。见图11. 12.3和图11 .12.4。 Diabetic macular edema (DME): May be present in any of thestages listed above. Clinic
5、ally significant macular edema (CSME) requires treatment and is defined as any oneof the following (see Figures 11.12.5 and11.12.6): 6、糖尿病性黄斑水肿（DME） 上述各期均可出现。有临床意义的黄斑水肿(CSME）需要治疗。出现以下情况之一，即可定义为有临床意义的黄斑水肿。见图和图。1 Retinal thickening within 500 m (one-third of disc diameter) of the fovealcenter. (1)黄斑中心
6、凹视网膜增厚1视盘直径(PD),且部分位于距黄斑中心凹1PD内。Differential Diagnosis for Nonproliferative Diabetic Retinopathy【非增殖型糖尿病视网膜病变的鉴别诊断】 Central retinal vein occlusion (CRVO): Opticdisc swelling, veins are more dilated and tortuous, hard exudates usually notfound, hemorrhages are nearly always in the nerve fiber layer (
7、“splinter hemorrhages”). CRVO is generally unilateral and of more sudden onset. See 11.8, Central Retinal Vein Occlusion. 1、视网膜中央静脉阻塞(CRVO)视盘水肿，静脉明显迂曲扩张，通常无硬性渗出，出血几乎均位于神经纤维层(裂片形出血)。视网膜中央静脉阻塞常为单侧发病，起病突然。参见本章第八节视网膜中央静脉阻塞。 Branch retinal vein occlusion (BRVO):Hemorrhages are distributed along a vein, a
8、nd do not cross the horizontal raphe(midline). See 11.9, Branch Retinal Vein Occlusion. 2、视网膜分支静脉阻塞(BRVO)出血沿静脉分支的走行分布，不越过水平中线。参见本章第九节视网膜分支静脉阻塞。 Ocular ischemic syndrome: Hemorrhages mostly in the midperiphery and larger; exudate is absent. Usually accompanied by pain;mild anterior chamber reaction;
9、corneal edema; episcleral vascular congestion;a mid-dilated, poorly reactive pupil; iris neovascularization. See 11.11,Ocular Ischemic Syndrome. 3、眼缺血综合征 出血斑较大，大多位于中周部视网膜，无渗出；通常伴有眼部疼痛；前房轻度炎症反应，角膜水肿，表层巩膜充血；瞳孔轻度散大，对光反应迟钝；虹膜新生血管。参见本章第十一节眼缺血综合征。 Hypertensive retinopathy: Hemorrhages fewerand typically f
10、lame-shaped, microaneurysms rare, and the arteriolar narrowing.See 11.10, Hypertensive Retinopathy. 4、高血压性视网膜病变 出血较多，呈火焰状，微血管瘤少见，视网膜动脉狭窄，常双眼发病。参见本章第十节高血压性视网膜病变。 Radiation retinopathy: Usually develops withina few years of radiation. Microaneurysms are rarely present. See 11.5, CottonWool Spot: Diffe
11、rential Diagnosis. 5、放射性视网膜病变 放疗后任何时间均可发病，多在头几年之内。微血管瘤极少见。曾行眼及其周围组织如脑、筛窦、鼻咽部放疗，眼睛受到辐射。即使放疗时有眼罩保护，也要高度警惕，一般放疗量3000cGY即可致病，但有放疗量1500cGY致病的报道。参见本章第五节棉绒斑的鉴别诊断。Differential Diagnosis For Proliferative Diabetic Retinopathy 【增殖型糖尿病性视网膜病变的鉴别诊断】 Neovascular complications of CRAO, CRVO, orBRVO: See 11.6, Cent
12、ral Retinal Artery Occlusion, 11.8, Central Retinal VeinOcclusion, 11.9, Branch Retinal Vein Occlusion. 1、视网膜中央动脉阻塞、视网膜中央静脉阻塞或视网膜分支静脉阻塞引起的新生血管。参见本章第六节视网膜中央动脉阻塞，第八节视网膜中央静脉阻塞，第九节视网膜分支静脉阻塞。 Sickle cell retinopathy: Peripheral retinalneovascularization. “Sea fans” of neovascularization present. See 11.2
13、0, Sickle Cell Disease(Including Sickle Cell, Sickle Trait). 2、镰状红细胞性视网膜病变 视网膜新生血管位于周边部，呈“海扇”形，黄斑一般不受累。参见本章第二十节镰状细胞病(包括镰状细胞病和镰状细胞素质)。 Embolization from i.v. drug abuse (e.g., talc retinopathy): History of i.v. drug abuse, peripheral retinal neovascularization, may see particles of talc in macular ve
14、ssels. See 11.33,Crystalline Retinopathy. 3、静脉吸毒性血管栓塞（滑石粉性视网膜病变） 有经静脉吸毒史，周边视网膜新生血管、黄斑区血管可见滑石粉颗粒。参见本章第三十三节结晶样视网膜病变。 Sarcoidosis: May have uveitis, exudates around veins (“candle-waxdrippings”), NVE,or systemic findings. See 12.6, Sarcoidosis. 4、结节病 可有葡萄膜炎、静脉旁渗出(蜡样小滴)、视网膜其他部位新生血管（NVE）或全身表现。参见第十二章第六节结节病。 Ocular ischemic syndrome: See above. 5、眼缺血综合征 如前所述。 Radiation retinopathy: See above. 6、放射性视网膜病变 如前所述。Work-Up【检查】1Slit-lampexaminatio
