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中國人之網膜血管疾病
Retinal Vascular Diseases among Chinese
並列摘要
I would like to express my deep gratitude for this flattering opportunity to present the special lecture at this Twentieth Annual Academic Meeting of the Ophthalmological Society of the Republic of China. Basing on experiences in studying retinovasculard iseases among Chinese for decades, the author discussed the topic in four parts: 1. Study related to hypertensive retinopathy. 2. Study related to retinal arteriolosclerosis. 3. Study related to diabetic retinopathy. 4. Others, including cholesterol embolus, ocular fundus in uremia, toxemia, black foot and etc. The essentials of the lecture mainly came from the author's publications regarding retinovascular diseases during the past twenty years. The followings are the several points of importance of the lecture: Ⅰ. Study related to hypertensive retinopathy 1. The degree of hypertensive retinopathy seems to be closely related with the blood pressure, especially the diasystolic pressure. 2. There is a correlation between the duration of hypertension but not to the retinal arteriolosclerosis, the longer hypertensive the earily the arteriolosclerosis developed. 3. Five-years mortality rate: Gr. Ⅰ 2.74%, Gr. Ⅱ 20.75%, Gr. Ⅲ 48.00%, Gr. Ⅳ 85.7 1%. Ten years mortality rate: Gr. Ⅰ 24.4%, Gr. Ⅱ 43.2%, Gr. Ⅲ 75.0%, Gr. Ⅳ 100%. 4. If hypertensive retinopathy persists for a period of time, the disc may appear a picture like neuritic finding. The two conditions should be differentiated. 5. In the Scheie's classification for hypertensive retinopathy, the author purposes to set a subgroup Ⅱ-A in Grade Ⅱ., because it will be much more convenient in pointing possible imminent C. V. A. 6. We found there are periarterial spaces and perivenous spaces in hypertensive retinopathy. When the retinal vessels demonstrate periarterial space, the diastolic pressure is relatively high as compared with those show no such space. On the other hand, when the retinal vessels demonstrate perivenous space, the systolic pressure is relatively high. The higher the pressure, the larger the space. This has been prooved by statistic study and fluorescein angiography. Ⅱ. Study related to retinal arteriolosclerosis 1. There is a correlation between the duration of hypertension and the retinal arteriolosclerosis. 2. It is significant that the correlation between serum cholesterol level and grading of retinal arteriolosclerosis. 3. Marked excavation of optic disc has been noted in arteriosclerotic patients in whom no evidences of glaucoma were mentioned. Ⅲ. Study related to diabetic retinopathy 1. The diabetic retinopathy was influenced by the patient's age, blood pressure, intraocular pressure, duration and treatment of disease. The data we collected for the time being will be the basis for further evaluation. 2. There are some useful tools which can be used to study diabetic retinopathy. Fluorescein angiography to demonstrate the changes of diabetic retinopathy, such as prolonged retinal circulation time, microanerysm, exudate, hemorrhage, neovascularization and proliferative tissure. The other useful tool may be ERG. 3. The changes of oscillatory potential on electroretinography occured soon after the onset of diabetic retinopathy. So ERG can be used to predict visual prognosis. 4. Xenon photocoagulation is effective in the treatment of macular edema & eraly proliferative changes. Ⅳ. Others, including cholesterol embolus, ocular fundus in uremia, and toxemia. 1. Three cases of cholesterol emboli in the retinal arteries have been reported. The significance of the discovery of the crystals in the life prognosis and of the possible complication in the cardiocarotid cerebral circulation were emphasized. 2. The main changes found in the ocular fundus of uremic patients are hypertensive retinopathy and retinal arteriolosclerosis. Some characteristic features are accompanied by, relatively pale & dirty retina, blurring of optic disc and high incidence of retinal arteriolosclerosis. 3. The ocular fundus change in toxemia of pregnancy mainly consist of hypertensive retinopathy and also show diffuse edema of retina. The appearance of edema is like that of seeing the bottom of a bucket through water. 4. Hypertensive fundus changes were more frequently seen in the patients with Black foot Disease than control group. Although no characteristic fundus fingings could be found in the patients with Blackfoot Disease.