糖尿病眼部并发症ppt课件.ppt

黄斑水肿、牵拉视网膜脱离 视物变形 阅读困难！ 生活自理困难！ 诊断-眼底荧光血管造影 协助诊断 引导激光治疗 评估疗效和预后 治疗（一）内科治疗 控制高血糖 长期稳定控制血糖可延缓DR的发展 药物治疗DR不满意：Aspirin, Diamox, Doxium 控制高血压、高血脂 控制其他糖尿病并发症：神经病变、肾病 治疗（二）激光治疗 激光来源于激发的光辐射（light amplification by stimulated emission of radiation) 激光输出平行伸展呈束状 不同波长激光有特异性靶组织反应 治疗（二）激光治疗 局部光凝 弥漫黄斑水肿：格珊样光凝 局部黄斑水肿：局部光凝 治疗目标：破坏通透性异常的血管或视网膜缺氧区， 限制异常通透，防止新生血管增殖。 治疗（二）激光治疗 全视网膜光凝： 增殖前期： 疏松激光 600-900灶， 200-500 ?m 增殖期： 密激光 1200-1600灶， 200-500 ?m 治疗目标：减少视网膜代谢需求, 减轻缺氧,促进NV消退 治疗（二）全视网膜激光治疗原理 PDR由于小血管闭锁，产生大面积无灌注区，刺激产生新生血管，受到玻璃体牵引而破裂出血，光凝周围视网膜，将视网膜变成瘢痕组织，可以阻断这一病理过程– 牺牲周边视力，保全中心视力 美国National Study对1700个患者，半数光凝，半数观察，光凝的半数患者预后比观察眼好得多 激光光斑反应强度的分级 I度：依稀可辨，淡灰色 II度：雾状混浊，半透明，灰色 III度：灰白色混浊，中央部白色 IV度：致密的熟蛋白样混浊，白色混浊 激光前 激光后 治疗（三） 玻璃体手术 小结 课后思考题： 糖尿病视网膜病变是如何分期的？ 其临床意义为何？ 课后阅读： 张承芬主编 《眼底病学》 教师信息：赵明威 转 眼科 zhaomingwei@ * THE EYE IS LIKE A CAMERA ? Light passes through the cornea and the lens of the eye and is focused on the retina in much the same way that an image is focused on the film of a camera. ?? The human eye is remarkable. It accommodates to changing lighting conditions and focuses light rays originating at various distances from the eye. When all of the components of the eye function properly, light is converted to impulses and conveyed to the brain where an image is perceived. The retina is analogous to the film of a camera. The cornea and lens focus light on the retina. The retina then changes light to electrical signals which are transmitted to the brain along the optic nerve. * Iris -- the colored part of the eye. The iris helps regulate the amount of light that enters the eye Pupil -- the dark center in the middle of the iris. The pupil determines how much light is let into the eye. It changes sizes to accommodate for the amount of light that is available. Cornea -- the clear front window of the eye.