WordNet

a disease of the retina that can result in loss of vision

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/20 07:25:08」(JST)

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Retinopathy is persistent or acute damage to the retina of the eye. Ongoing inflammation and vascular remodeling may occur over periods of time where the patient is not fully aware of the extent of the disease. Frequently, retinopathy is an ocular manifestation of systemic disease as seen in diabetes or hypertension.^[1] Diabetic retinopathy is the leading cause of blindness in working-aged people.^[2]

Pathophysiology

Causes of retinopathy include but are not limited to:

Diabetes mellitus, which causes diabetic retinopathy
Arterial hypertension, which causes hypertensive retinopathy
Retinopathy of prematurity due to prematurity of the newborn (under the 9 months of human pregnancy).
Radiation retinopathy due to exposure to ionizing radiation.
Solar retinopathy due to direct sunlight exposure.
Sickle cell disease
Retinal vascular disease such as retinal vein or artery occlusion.
Trauma, especially to the head, and several diseases may cause Purtscher's retinopathy
Hyperviscosity-related retinopathy as seen in disorders which cause paraproteinemia

Many types of retinopathy are proliferative, most often resulting from neovascularization or blood vessel overgrowth. Angiogenesis is the hallmark precursor that may result in blindness or severe vision loss, particularly if the macula becomes affected.^[1]

Retinopathy may more rarely be due to ciliopathic genetic disorders, such as Alström syndrome or Bardet–Biedl syndrome.^[3]

Retinopathy is diagnosed by an ophthalmologist during eye examination. Treatment depends on the cause of the disease.

Remote Screening

Telemedicine programs are available that allow primary care clinics to take images using specially designed retinal imaging equipment which can then be shared electronically with specialists at other locations for review.^[4] In 2009, Community Health Center, Inc. implemented a telemedicine retinal screening program for low-income patients with diabetes as part of those patients annual visits at the Federally Qualified Health Center.^[5]

Treatment

Treatment is based on the cause of the retinopathy and may include laser therapy to the retina. In recent years targeting the pathway controlling vessel growth or angiogenesis has been promising. Vascular endothelial growth factor (VEGF) seems to play a vital role in promoting neovascularization. Using anti-VEGF drugs (antibodies to sequester the growth factor), researches have shown significant reduction in the extent of vessel outgrowth. Several anti-VEGF treatments are currently under review in both clinical trials and in preclinical labs.^[1]

References

^ ^a ^b ^c American Academy of Ophthalmology (2012). Retina and vitreous (2011-2012 ed.). p. 271. ISBN 9781615251193.
^ Cheung, Ning (June 26, 2010). "Diabetic retinopathy". doi:10.1016/S0140.
^ Badano JL, Mitsuma N, Beales PL, Katsanis N (2006). "The ciliopathies: an emerging class of human genetic disorders". Annu Rev Genomics Hum Genet 7: 125–48. doi:10.1146/annurev.genom.7.080505.115610. PMID 16722803.
^ "Remote Retinal Screening Facilitates Diagnosis and Treatment of Retinopathy for Poor and/or Uninsured Patients With Diabetes in Rural California". Agency for Healthcare Research and Quality. 2013-10-03. Retrieved 2013-08-01.
^ "Telemedicine-Based Eye Examinations Enhance Access, Reduce Costs, and Increase Satisfaction for Low-Income and Minority Patients with Diabetes". Agency for Healthcare Research and Quality. 2013-07-17. Retrieved 2013-08-01.

UpToDate Contents

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1. 糖尿病性網膜症：分類および臨床的特徴 diabetic retinopathy classification and clinical features
2. 糖尿病性網膜症：予防および治療 diabetic retinopathy prevention and treatment
3. 糖尿病性網膜症：病因 diabetic retinopathy pathogenesis
4. 糖尿病性網膜症：スクリーニング diabetic retinopathy screening
5. 未熟児網膜症 retinopathy of prematurity

English Journal

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples.

Spurr S1, Bullin C1, Bally J1, Trinder K2, Khan S3.
International journal of circumpolar health.Int J Circumpolar Health.2018 Dec;77(1):1422670. doi: 10.1080/22423982.2017.1422670.
PMID 29384012

Intrauterine infection, immune system and premature birth.

Helmo FR1, Alves EAR2, Moreira RAA2, Severino VO1, Rocha LP1, Monteiro MLGDR1, Reis MAD1, Etchebehere RM3, Machado JR1,4, Corrêa RRM1.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2018 May;31(9):1227-1233. doi: 10.1080/14767058.2017.1311318. Epub 2017 Apr 20.
PMID 28423971

Conditional copula models for right-censored clustered event time data.

Geerdens C1, Acar EF2, Janssen P1.
Biostatistics (Oxford, England).Biostatistics.2018 Apr 1;19(2):247-262. doi: 10.1093/biostatistics/kxx034.
PMID 28968642

Japanese Journal

Anti-Hexokinase 1 Antibody as a Novel Serum Biomarker of a Subgroup of Diabetic Macular Edema

Yoshitake Tatsuya,Murakami Tomoaki,Yoshitake Shin,Suzuma Kiyoshi,Dodo Yoko,Fujimoto Masahiro,Ito Shinji,Tsujikawa Akitaka
Scientific Reports (9), 2019-12-01
… Diabetic retinopathy (DR) induces the breakdown of the blood-retinal barrier and promotes neuroinflammation, although autoimmune responses to sequestered retinal antigens remain poorly understood. …
NAID 120006596560

Achieving LDL cholesterol target levels <1.81 mmol/L may provide extra cardiovascular protection in patients at high risk: Exploratory analysis of the Standard Versus Intensive Statin Therapy for Patients with Hypercholesterolaemia and Diabetic Retinopathy study

Itoh Hiroshi,Komuro Issei,Takeuchi Masahiro,Akasaka Takashi,Daida Hiroyuki,Egashira Yoshiki,Fujita Hideo,Higaki Jitsuo,Hirata Ken-ichi,Ishibashi Shun,Isshiki Takaaki,Ito Sadayoshi,Kashiwagi Atsunori,Kato Satoshi,Kitagawa Kazuo,Kitakaze Masafumi,Kitazono Takanari,Kurabayashi Masahiko,Miyauchi Katsumi,Murakami Tomoaki,Murohara Toyoaki,Node Koichi,Ogawa Susumu,Saito Yoshihiko,Seino Yoshihiko,Shigeeda Takashi,Shindo Shunya,Sugawara Masahiro,Sugiyama Seigo,Terauchi Yasuo,Tsutsui Hiroyuki,Ueshima Kenji,Utsunomiya Kazunori,Yamagishi Masakazu,Yamazaki Tsutomu,Yo Shoei,Yokote Koutaro,Yoshida Kiyoshi,Yoshimura Michihiro,Yoshimura Nagahisa,Nakao Kazuwa,Nagai Ryozo
Diabetes Obesity & Metabolism 21(4), 791-800, 2019-04
… Aims To assess the benefits of intensive statin therapy on reducing cardiovascular (CV) events in patients with type 2 diabetes complicated with hyperlipidaemia and retinopathy in a primary prevention setting in Japan. … Conclusions This post hoc analysis suggests that achieving LDL cholesterol target levels <1.81 mmol/L may more effectively reduce CV events than achieving target levels >= 2.59 to <3.10 mmol/L in patients with hypercholesterolaemia and diabetic retinopathy. …
NAID 120006601525

統合的アプローチによる糖尿病網膜症研究の新展開 (第122回日本眼科学会総会評議員会指名講演生体イメージングと眼病理)

植村明嘉,小椋俊太郎,倉田薫里,小峯祐美,大矢恵,井上奈緒美,小椋祐一郎,高瀬弘嗣,宮田卓樹,福嶋葉子,楠原仙太郎,平島正則,池田わたる,南敬,渋谷正史,吉田富,Mann Fanny,酒井秀人,奈良裕美,Yancopoulos George D,Wiegand Stanley J,Kim Pilhan,Koh Gou Young,西川伸一
日本眼科学会雑誌 123(3), 312-336, 2019-03
NAID 40021836209

Related Pictures

★リンクテーブル★

リンク元	「100Cases 16」「網膜症」「retinal disease」
拡張検索	「chorioretinopathy」「diabetic retinopathy」

「100Cases 16」

Retinopathy
Classification and external resources
Specialty	ophthalmology
ICD-10	H35-H35.2
ICD-9-CM	362.0-362.2

　　[★]

☆case16　膝の痛み

■glossary

indigestion 消化障害、消化不良

■症例

80歳　男性

主訴：左膝の痛みと腫脹

現病歴：左膝の痛みを2日前から認めた。膝は発熱・腫脹しており、動かすと疼痛を生じる。時々胸焼けと消化不良が見られる。6ヶ月前のhealth checkで、高血圧(172/102mmHg)と血中クレアチニンが高い(正常高値)こと以外は正常といわれた。その4週間数回血圧を測定したが、高値が継続したため、2.5mg bendrofluamethizide(UK)/ベンドロフルメチアジド bendroflumethiazide(US)で治療を開始した。最近の血圧は138/84 mmHgであった。

喫煙歴：なし。

飲酒歴：一週間に平均4unit。

既往歴：股関節に中程度(mild)の変形性関節症

家族歴：特記なし

服薬歴：アセトアミノフェン(股関節の疼痛に対して)

身体所見 examination

　血圧 142/86mmHg。体温37.5℃。脈拍88/分。grade 2 hypertensive retinopathy(高血圧症性網膜症)。心血管系、呼吸器系に検査場異常なし。手にDIPにヘバーデン結節なし。

　左膝が発熱し腫脹している。関節内に液、patellar tap陽性。90℃以上膝関節を屈曲させると痛みを生じる。右の膝関節は正常に見える。

検査　 investigation

　生化学：白血球増多、ESR 上昇、尿素高値、グルコース高値

　単純X線：関節間隙やや狭小。それ以外に異常は認めない。

■problem list

　#1 左膝の痛み

　#2 胸焼け

　#3 消化不良

　#4 高血圧

　#5 クレアチニン正常高値

　#6 股関節の変形性リウマチ

　#7 高血圧性網膜症

■考え方

　・関節痛の鑑別診断を考える。

　・VINDICATEで考えてみてもよいでしょう。

　・関節痛の頻度としては　外傷＞慢性疾患(OAなど)＞膠原病＞脊椎疾患＞悪性腫瘍

■関節痛の鑑別疾患

DIF 282

V Vascular 血友病 hemophilia, 壊血病 scurvy, 無菌性骨壊死 aseptic bone necrosis (Osgood-Schlatter diseaseとか)

I Inflammatory 淋疾 gonorrhea, ライム病 lyme disease, 黄色ブドウ球菌 Staphylococcus, 連鎖球菌 Streptococcus, 結核 tuberculosis, 梅毒 syphilis, 風疹 rubella, 単純ヘルペス herpes simplex, HIV human immunodeficiency virus, サイトメガロウイルス cytomegalovirus

N Neoplastic disorders 骨原性肉腫 osteogenic sarcoma, 巨細胞腫 giant cell tumors

D Degenerative disorders degenerative joint disease or 変形性関節症 osteoarthritis

I Intoxication 痛風 gout (uric acid), 偽痛風 pseudogout (calcium pyrophosphate), ループス症候群 lupus syndrome of hydralazine (Apresoline) and procainamide, gout syndrome of diuretics

C Congenital and acquired malformations bring to mind the joint deformities of tabes dorsalis and syringomyelia and congenital dislocation of the hip. Alkaptonuria is also considered here.