糖尿病視網膜病變(糖尿上眼)

Diabetic Retinopathy

 

 

上圖為糖尿病視網膜病變(未有玻璃體出血)眼底照,可見清楚看見眼底滲出物、激光疤、火焰狀出血。

 

上圖為糖尿病視網膜病變後期,伴有玻璃體牽拉及激光疤,黃斑瘢痕,視力明顯變差。

   

「糖尿上眼」即糖尿病視網膜病變,是糖尿病併發症一種,即中醫「消渴目病」。早期症狀主要為視力下降及視物變形。若視網膜新生血管大量出血進入玻璃體腔,則出現視力嚴重障礙。病程繼續發展可引起牽拉性視網膜脫離、繼發性青光眼,導致視力明顯下降及視野缺損,甚或失明。

前人早在《秘傳證治要訣》指出:“三消久之,神血既虧,或目無所見,或手足偏廢”。

由於糖尿上眼可有不同臨床表現,可將它們分類為中醫眼科疾患中的視瞻昏渺 (視力緩緩下降)、雲霧移睛(飛蚊症)、暴盲(視力突然下降)、血灌瞳神   (前房積血)等。中醫眼科跟據其病患特點及辨證作為治療依據。

非增殖型糖尿病視網膜病變

圖1 糖尿病視網膜眼底,可見黃斑出血及滲出物

 

圖2 糖尿病視網膜眼底,可見黃斑水腫、視網膜有廣泛出血及滲出物

 

圖3 玻璃體積血

控制血糖是治療此病重要基礎治療,由於此病眼局部病變是多種多樣,故透過眼底檢查、螢光造影、OCT檢查等手段對中醫眼科治療有極大幫助,治療時可將它們歸納為中醫望診內容。

至於視網膜及玻璃體出血量大時,使視力嚴重下降,可配合針灸治療;並按照出血病程各階段用藥作相對應治療。

此病早期,接受中醫眼科治療可改善視力及減慢病程進一步轉壞,中醫眼科對治療這病時有其獨特而療效顯著之特性。

糖尿病視網膜病變病例

 

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