抗VEGF治疗对糖尿病视网膜病变视网膜缺血的影响

Effect of anti-VEGF therapy on retinal ischemia in diabetic retinopathy

视网膜缺血是糖尿病视网膜病变(dabetic retinopathy, DR)的表现之一,临床上常以视网膜无灌注区(retinal nonperfusion, RNP)范围和面积反映视网膜缺血的严重程度。RNP的发生发展与视网膜中血管内皮生长因子(vascular endothelial growth factor, VEGF)高表达紧密相关。研究表明,VEGF可诱导内皮细胞肥大、白细胞募集和聚集,阻塞血管腔形成RNP,而抗VEGF治疗可有效减轻或逆转这一病理过程。然而,临床研究数据分析表明,抗VEGF治疗可减轻RNP,但不能完全阻止RNP的进展;采用OCTA研究抗VEGF治疗对视网膜内微血管异常(intraretinal microvascular abnormalities,IRMA)及邻近视网膜灌注情况影响结果表明,抗VEGF治疗总体上有助于改善视网膜灌注,但抗VEGF治疗对IRMA及其周围RNP的影响也呈现差异化表现:抗VEGF治疗的结果可能是RNP通过再灌注而减轻,也可能是稳定,还有可能会出现RNP扩大。进一步研究抗VEGF治疗后RNP扩大的机制对于彻底阻止甚至逆转DR的视网膜缺血和RNP有重要意义。

Retinal ischemia is one of complications of diabetic retinopathy(DR),commonly evaluated by retinal nonperfusion area(RNP)which has a strong relationship with high expression of vascular endothelial growth factor(VEGF)in the process of DR.Previous studies found that VEGF played an important role in endothelial cell hypertrophy,leukocyte plugging in the development of retinal vessel closure,while RNP could be successfully improved after anti-VEGF treatment.However,many clinical data showed that anti-VEGF treatment was incapable of stopping the progression of RNP.Besides,the studies based on OCTA demonstrated that anti-VEGF contributed to retinal reperfusion,but the effect on intraretinal microvascular abnormalities(IRMA)and RNP around showed different results:RNP could be reperfused,stable or deteriorated.Further studies about the mechanism of anti-VEGF on RNP deterioration are still needed for stopping even reversing retinal ischemia and RNP in DR.(Int Rev Ophthalmol,2022,46:1-4)