小结
定义
病史和体格检查
关键诊断因素
- diabetes
其他诊断因素
- microaneurysms
- cotton wool spots
- intraretinal hemorrhage
- lipid exudates
- macular edema
- venous beading
- intraretinal microvascular abnormalities
- optic disk neovascularization
- retinal neovascularization
- preretinal or vitreous hemorrhage
- retinal detachment
危险因素
- longer duration of diabetes
- poor glycemic control
- elevated lipid levels
- hypertension
- renal disease
- ethnicity
- pregnancy
- cataract surgery
诊断性检查
首要检查
- optical coherence tomography
- fundus photography/wide-field fundus photography
需考虑的检查
- fluorescein angiography/wide-field fluorescein angiography
- optical coherence tomography angiography
- B-scan ultrasonography
治疗流程
nonproliferative diabetic retinopathy
proliferative diabetic retinopathy
iris neovascularization
advanced proliferative diabetic retinopathy
macular edema unresponsive to intravitreal anti-VEGF therapy
macular edema with anteroposterior vitreomacular traction
chronic macular edema, macular ischemia, chronic macular detachment, optic atrophy secondary to neovascular glaucoma
撰稿人
作者
Jonathan Dowler, MD, FRCS, FRCOphth
Consultant Ophthalmic Surgeon
The London Clinic
London
UK
利益声明
JD declares that he has no competing interests.
鸣谢
Dr Jonathan Dowler would like to gratefully acknowledge Dr Robin Hamilton, a previous contributor to this topic.
利益声明
RH declares that he has no competing interests.
同行评议者
Adrienne W Scott, MD
Chief
Wilmer Eye Institute
Bel Air
Associate Professor of Ophthalmology
Johns Hopkins University School of Medicine
Baltimore
MD
利益声明
AWS has received grant support and consulting honoraria from Genentech/Roche. She has also received consulting honoraria from Allergan/AbbVie Inc., Novartis, Regeneron, Bausch and Lomb, and Alimera Sciences.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
American Academy of Ophthalmology. Preferred practice pattern: diabetic retinopathy. Oct 2019 [internet publication].全文
Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: The International Council of Ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018 Oct;125(10):1608-22.全文 摘要
Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Mar;40(3):412-8.全文 摘要
American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.全文
American Academy of Ophthalmology. Preferred practice patterns: retina summary benchmarks. Dec 2023 [internet publication].全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Ocular ischemic syndrome
- Radiation retinopathy
- Retinal venous occlusion
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