Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Graefes Arch Clin Exp Ophthalmol. 2010 Jul;248(7):915-30. doi: 10.1007/s00417-010-1315-z. Epub 2010 Feb 20.
Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population worldwide. Many observational and preclinical studies have implicated vascular endothelial growth factor (VEGF) in the pathogenesis of DR, and recent successes with anti-VEGF therapy for age-related macular degeneration (AMD) have prompted research into the application of anti-VEGF drugs to DR. Here we review the numerous early studies that suggest an important potential role for anti-VEGF agents in the management of diabetic retinopathy.
For diabetic macular edema, phase II trials of intravitreal pegaptanib and intravitreal ranibizumab have shown short-term benefit in visual acuity. Intravitreal bevacizumab also has been shown to have beneficial short-term effects on both visual acuity and retinal thickness. For proliferative diabetic retinopathy (PDR), early studies suggest that intravitreal bevacizumab temporarily decreases leakage from diabetic neovascular lesions, but this treatment may be associated with tractional retinal detachment (TRD). Furthermore, several studies indicate that bevacizumab is likely to prove a helpful adjunct to diabetic pars plana vitrectomy (PPV) for TRD. Finally, three small series suggest a potential beneficial effect of a single dose of bevacizumab to prevent worsening of DME after cataract surgery. Use of anti-VEGF medications for any of these indications is off-label. Despite promising early reports on the safety of these medications, we eagerly await the results of large, controlled trials to substantiate the safety and efficacy of anti-VEGF drugs for diabetic retinopathy.
糖尿病性视网膜病变（DR）是全球工作年龄段人群视力丧失的主要原因。许多观察性和临床前研究表明血管内皮生长因子（VEGF）在 DR 的发病机制中起作用，并且抗 VEGF 治疗年龄相关性黄斑变性（AMD）的近期成功促使人们研究将抗 VEGF 药物应用于 DR。在这里，我们回顾了许多早期研究，这些研究表明抗 VEGF 药物在糖尿病性视网膜病变的治疗中有重要的潜在作用。
对于糖尿病性黄斑水肿，玻璃体内注射培加他滨和玻璃体内注射雷珠单抗的 II 期临床试验表明在视力方面有短期获益。玻璃体内注射贝伐单抗也显示出对视力和视网膜厚度均有短期有益的影响。对于增生性糖尿病性视网膜病变（PDR），早期研究表明，玻璃体内注射贝伐单抗可暂时减少糖尿病新生血管病变的渗漏，但这种治疗可能与牵引性视网膜脱离（TRD）有关。此外，几项研究表明，贝伐单抗可能是治疗 TRD 的糖尿病 pars plana 玻璃体切除术（PPV）的有用辅助手段。最后，三个小系列研究表明单次贝伐单抗剂量可预防白内障手术后 DME 的恶化，有潜在的有益作用。任何这些适应症的抗 VEGF 药物的使用均为超适应证用药。尽管这些药物的安全性有早期的良好报告，但我们急切等待大型对照试验的结果，以证实抗 VEGF 药物治疗糖尿病性视网膜病变的安全性和有效性。
