Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA.
Eye (Lond). 2010 Mar;24(3):428-34. doi: 10.1038/eye.2009.335. Epub 2010 Jan 15.
Diabetic retinopathy is the most common cause of vision loss in working-age adults. Both inflammation and vascular endothelial growth factor (VEGF) play a critical role, modern and emerging treatments have centred on both laser photocoagulation and new pharmacologic strategies to improve the prognosis. Focal and grid photocoagulation, as described in the ETDRS trials, remain the gold standard of treatment. New classes of agents include long-acting steroid formulations delivered as intravitreal injections and also anti-VEGF agents. In addition, studies are under way to evaluate potential benefits from other novel agents, including those acting on the mammalian target of rapamycin pathway. In limited numbers of direct head-to-head comparisons, both steroids and anti-VEGF agents appear to be superior to conventional photocoagulation in reducing macular oedema in the first 4-6 months after treatment, although laser photocoagulation appears to be superior at time points of 1-2 years. In addition, there appear to be significant potential long-term complications of steroids including cataracts and glaucoma that may limit their use in certain patients. New methods of the laser delivery including shorter pulse durations and pattern scanning may also improve the effectiveness and risk profile of laser from the patient prospective. Finally, multi-modality therapy may play an increasingly important role.
糖尿病性视网膜病变是工作年龄成年人视力丧失的最常见原因。炎症和血管内皮生长因子 (VEGF) 都起着至关重要的作用，现代和新兴的治疗方法集中在激光光凝和改善预后的新药物策略上。正如 ETDRS 试验中所述的局部和格栅光凝仍然是治疗的金标准。新的药物类别包括作为玻璃体内注射剂递送的长效类固醇制剂，以及抗 VEGF 药物。此外，正在进行研究以评估其他新型药物的潜在益处，包括那些作用于哺乳动物雷帕霉素靶蛋白途径的药物。在为数不多的直接头对头比较中，类固醇和抗 VEGF 药物似乎在治疗后 4-6 个月内减少黄斑水肿方面优于传统的光凝，尽管激光光凝在 1-2 年内的时间点似乎更有优势。此外，类固醇可能会引起严重的长期并发症，包括白内障和青光眼，这可能会限制它们在某些患者中的使用。包括更短的脉冲持续时间和模式扫描在内的新的激光输送方法也可能从患者的角度提高激光的有效性和风险状况。最后，多模式治疗可能会发挥越来越重要的作用。
