斜视与弱视课件

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1、DiabeticRetinopathyEpidemiology(TheWorldHealthOrganisation(1992)definitionofblindnessisvisionlessthan3/60inthebettereyewithbestavailablespectaclecorrection.)Diabetesisthereforeoneofthemostseriouschallengestohealthcareworld-wide.Accordingtorecentprojectionsitwillaffect239millionpeopleby2010-doubling

2、inprevalencesince1994.Diabeteswillaffect28millioninwesternEurope,18.9millioninNorthAmerica138.2millioninAsia,1.3millioninAustralasia.Diabetesmellitusisthemostcommoncauseofblindnessamongstindividualsofworking-age(20-65years).TheprevalenceofblindnessduetoDRinWesternCommunitiesisestimatedasbetween1.6-

3、1.9/100,000PresentationAbout2%oftype2diabeticshaveCSMEatdiagnosisand10.2%haveothersignsofDRalreadypresentwhentheirdiabetesisdiscovered.Mitchellandco-workersfoundthat15.8%ofundiagnoseddiabeticsinanelderlyAustralianpopulationhadsignsofDR,accordingtotherecentBlueMountainsEyeStudy.Indeeditmayoftentakef

4、rom9-12yearsfortype2diabetestobediagnosedAclassificationofdiabeticretinopathyAusefulclassificationaccordingtothetypesoflesionsdetectedonfundoscopyisasfollows:Non-proliferativediabeticretinopathy(NPDR)Mildnon-proliferativediabeticretinopathyMicroaneurysmsDotandblothaemorrhagesHard(intra-retinal)exud

5、atesModerate-to-severenon-proliferativediabeticretinopathyTheabovelesions,usuallywithexacerbation,plus:Cotton-woolspotsVenousbeadingandloopsIntraretinalmicrovascularabnormalities(IRMA)ProliferativediabeticretinopathyNeovascularizationoftheretina,opticdiscoririsFibroustissueadherenttovitreousfaceofr

6、etinaRetinaldetachmentVitreoushaemorrhagePreretinalhaemorrhageMaculopathyClinicallysignificantmacularoedema(CSME)IschaemicMaculopathyPathogenesisofDiabeticMicroangiopathyHyperglycaemiacauses-BMthickeningnonenzymaitcglycosylationincreasedfreeradicalactivityincreasedfluxthroughthepolyolpathwayosmotic

7、damageHaemostaticabnormalitiesofthemicrocirculation-Ithasalsobeenpostulatedthatplateletabnormalitiesindiabeticsmaycontributetodiabeticretinopathy.Therearethreestepsinplateletcoagulation:initialadhesion,secr