Arevalo J Fernando, Garcia-Amaris Rafael A
Clinica Oftalmologica Centro Caracas, Caracas, Venezuela.
Curr Diabetes Rev. 2009 Feb;5(1):39-46. doi: 10.2174/157339909787314121.
Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels from the retina or optic nerve, is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab on DR including DME and PDR. The results indicate that intravitreal bevacizumab injections may have a beneficial effect on macular thickness and visual acuity (VA), independent of the type of macular edema that is present. Therefore, in the future this new treatment modality could replace or complement focal/grid laser photocoagulation in DME. In addition, in PDR, this new option could be an adjuvant agent to PRP so that more selective therapy may be applied.
糖尿病视网膜病变（DR）仍然是工作年龄人群视力的主要威胁。糖尿病性黄斑水肿（DME）是DR的一种表现，可导致中心视力丧失。在9%的糖尿病患者中存在黄斑中心凹1个视盘直径范围内的黄斑水肿。增殖性糖尿病视网膜病变（PDR）是糖尿病患者视力丧失的主要原因。在PDR中，视网膜或视神经新生血管的生长被认为是由于血管内皮生长因子（VEGF）作为对缺血的反应释放到玻璃体腔中所致。此外，VEGF增加血管通透性，导致蛋白质在间质中沉积，促进血管生成和黄斑水肿的过程。本综述展示了玻璃体内注射贝伐单抗对包括DME和PDR在内的DR的多种益处。结果表明，玻璃体内注射贝伐单抗可能对黄斑厚度和视力（VA）有有益影响，而与存在的黄斑水肿类型无关。因此，在未来，这种新的治疗方式可能会取代或补充DME的局部/格栅激光光凝治疗。此外，在PDR中，这种新选择可能是全视网膜光凝（PRP）的辅助药物，从而可以应用更具选择性的治疗方法。
