我国糖尿病视网膜病变临床诊疗指南(2022年)——基于循证医学修订

Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)

糖尿病视网膜病变(DR)是工作年龄人群首位的致盲眼病。作为糖尿病的主要微血管并发症,DR所导致的盲和低视力已成为重大公共卫生问题。DR是糖尿病导致的视网膜微血管损害所引起的一系列病变;糖尿病黄斑水肿(DME)则是由于黄斑区毛细血管渗漏所致的视网膜增厚,主要影响中心视力。随着超广角眼底成像和光相干断层扫描血管成像等眼底检查诊疗技术的长足发展,DR和DME的诊断评估手段得以不断完善和便捷,同时也发现了一些基于影像学的生物学标志物可以帮助指导治疗决策和判断预后。近年来,DR和DME的治疗手段变得更为丰富,除经典的激光光凝治疗以外,抗血管内皮生长因子药物现已成为累及黄斑中心DME治疗的一线方案;此外,眼内缓释糖皮质激素类药物、微脉冲激光等,也被证明对DME有效。不同的药物、不同的治疗方案、药物与手术的联合治疗、药物和激光光凝的联合治疗等为患者提供了多样化的选择,也为临床医生制定合适的诊疗方案提出了新的挑战。基于此,为了更好地指导我国眼科医师的临床实践,中华医学会眼科学分会眼底病学组、中国医师协会眼科医师分会眼底病学组与国家眼部疾病临床医学研究中心基于最新的循证医学证据,制订了《我国糖尿病视网膜病变临床诊疗指南(2022年)——基于循证医学修订》。本指南将有助于规范我国DR的预防、筛查、转诊、干预、全身管理和患者教育等。

Diabetic retinopathy(DR),a microvascular complication from diabetes,is the leading cause of blindness among working-age population.The blindness and low vision caused by DR has become a major public health issue.DR is a condition that occurs when diabetes affects the microvasculature and nerve tissue in the retina.Diabetic macular edema(DME),featured by thickened retina from capillary leakage in the macular area,mainly impacts central vision.The diagnostic assessment and treatment options of DR have improved dramatically in recent years.Recent advances in diagnostic assessment include the introduction of wide-field imaging and optical coherence tomography angiography,which have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in DME.Recently,treatment of DR and DME has been diversified:apart from the classic laser photocoagulation therapy,anti-vascular endothelial growth factor has become the first-line therapy for central-involved DME.In addition,steroids and micropulse laser have maintained a role in the management of DME in specific situations.Different combinations of medicine,surgery and laser treatments offered various options for patients,while making it more challenging for clinical doctors to propose the most appropriate solution.In such circumstances,Fundus Disease Group of Ophthalmological Society of Chinese Medical Association,Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association,and National Clinical Research Center for Eye Diseases incorporated the best updated knowledge and evidence and developed Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China(2022).The guideline aims to standardize and offer a comprehensive guide for DR prevention,screening,referral and follow-up schedule,and appropriate management of DR in different stage,including DME,as well as systemic management and patient education.