O'Doherty M, Dooley I, Hickey-Dwyer M
Limerick Regional Hospital, Limerick, Ireland.
Br J Ophthalmol. 2008 Dec;92(12):1581-90. doi: 10.1136/bjo.2008.144550. Epub 2008 Oct 24.
This review discusses the evolution of the treatment of diabetic macular oedema and gives helpful guidelines in the treatment of diabetic macular oedema based on available evidence to date.
A literature search of all English articles from the Medline and Cochrane database was performed. The search was limited to only English randomised controlled clinical trials in humans. Overall, 93 articles were cited from 1979 to 2007. Of these, 31 articles corresponded to subject matter. Studies were evaluated on a standardised data extraction form and tabulated for easy review.
There is good evidence that laser treatment preserves vision in eyes with diabetic macular oedema (DMO). However, laser is a potentially destructive form of treatment which may be of greater benefit in combination with newer forms of treatment such as intravitreal steroid or intravitreal antiangiogenic agents. Current evidence does not support a clear benefit for surgical intervention in DMO.
Although laser treatment remains the cornerstone of treatment in diabetic macular oedema, the literature is beginning to support combination therapy. Using one or two intravitreal injections to reduce central macular thickness followed by focal or grid laser to give a sustained response may offer an alternative to treatment in DMO.
本综述探讨了糖尿病性黄斑水肿治疗方法的演变，并根据目前可得的证据，为糖尿病性黄斑水肿的治疗提供有益的指导方针。
对来自Medline和Cochrane数据库的所有英文文章进行文献检索。检索仅限于人类的英文随机对照临床试验。总体而言，从1979年至2007年共引用了93篇文章。其中，31篇文章与主题相关。研究通过标准化的数据提取表进行评估，并制成表格以便于查阅。
有充分证据表明，激光治疗可保留糖尿病性黄斑水肿（DMO）患者眼睛的视力。然而，激光是一种具有潜在破坏性的治疗方式，与玻璃体内注射类固醇或玻璃体内抗血管生成药物等新型治疗方法联合使用可能更有益。目前的证据不支持手术干预对DMO有明显益处。
尽管激光治疗仍然是糖尿病性黄斑水肿治疗的基石，但文献开始支持联合治疗。使用一到两次玻璃体内注射以减少黄斑中心厚度，随后进行局部或格栅激光治疗以获得持续反应，可能为DMO的治疗提供一种替代方案。
