玻璃体切割手术治疗糖尿病黄斑水肿的研究现状与进展

The progress of vitreous surgery for diabetic macular edema

糖尿病黄斑水肿(DME)是导致糖尿病视网膜病变患者视功能损害的主要原因。DME主要治疗方法包括玻璃体腔注射抗VEGF药物、糖皮质激素以及激光光凝等,但仍有部分患者对非手术治疗无反应或反应很差。临床和基础研究也都证实玻璃体视网膜界面的异常在DME的发病机制中具有重要作用,玻璃体切割手术(PPV)可以解除黄斑牵拉,清除玻璃体腔VEGF及其他炎性细胞因子,增加玻璃体腔氧浓度,改善视网膜供氧,降低牵拉性和非牵拉性DME的视网膜厚度,改善患者视力。但在具体实践中如何选择和应用PPV治疗DME,并进一步提高PPV的疗效,包括手术技术的创新、联合治疗以及手术时机的选择等问题,尚需要更多的临床研究加以探讨。

Diabetic macular edema(DME)is the main cause of visual impairment in patients with diabetic retinopathy(DR).Currently,the main treatment methods of DME include intravitreal injection of anti-VEGF drugs,glucocorticoids and laser photocoagulation,but there are still some patients who do not respond or respond poorly to non-surgical treatments.Clinical and basic studies have confirmed that the abnormality of the vitreous-retinal interface plays an important role in the pathogenesis of DME.Par plana vitrectomy(PPV)can relieve macular traction,clear the vitreous cavity VEGF and other inflammatory cytokines,increase the vitreous cavity oxygen concentration,improve retinal oxygen supply,reduce retinal thickness of traction and non-traction DME,and improve patients'vision.However,how to choose and apply PPV to treat DME in specific practice,and to further improve the efficacy of PPV,including the innovation of surgical technology,combined treatment and the choice of surgical timing,still needs more clinical studies to explore.