浅析糖尿病视网膜病变的治疗趋势

Analysis of Trends in the Treatment of Diabetic Retinopathy

目的糖尿病视网膜病变系全球范围的严重致盲性眼病。严格控制血糖、血压是控制其进展的基础;激光光凝和玻璃体视网膜手术仍是基本的治疗方法。方法随着抗血管内皮细胞生长因子药物的出现和玻璃体腔途径注射糖皮质激素等的探索,使得糖尿病视网膜病变的治疗逐渐成为一种综合性的治疗模式,但新疗法的有效性和安全性仍需严格评价。结果近30年来,国内外进行了多个重要的大型多中心随机对照临床研究以及高质量的临床流行病学调查,回答了一些问题,但同时也存在矛盾和争议。结论本文在回顾糖尿病视网膜病变治疗领域取得成就的同时,指出目前研究领域面临的问题及困惑,并探讨未来糖尿病视网膜病变的治疗趋势。

Objective Diabetic retinopathy（DR）remains one of the leading risk factors and causes of blindness worldwide. Tight glycemic and blood pressure control remains the cornerstone in the primary prevention of DR. Laser photocoagulation and vitreoretinal surgery remain the conventional management of DR.Methods New therapies,such as intraocular injection of anti-vascular endothelial growth factor（anti-VEGF）agents and corticosteroidscould be useful in patients who respond poorly to conventional therapy and al together cal for the comprehensive treatment mode for DR. Evaluation of the utility of these new approaches awaited the efficacy and safety results of properly designed large clinical trials.ResultsA series of large multicenter randomized controled trials and high quality epidemiology research conducted over the past three decades have not only answered some questions about DR therapy,but also initiated the contradiction and controversy.ConclusionThis article reviewed the advance in treatment of DR and brought out the questions and confusion in the current studies. The outlook for future treatment modalities,such as intravitreal steroid,anti-VEGF,protein kinase C inhibitors and other potential therapies for DR is promising.