Endocrine Research Center (Firouzgar), Institute of Endocrinology and Metabolism, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Arch Iran Med. 2012 Oct;15(10):635-40.
Diabetes mellitus is a global health problem affecting 366 million people worldwide and its prevalence is growing rapidly. Diabetic eye disease is present in up to 25% of diabetic subjects. Diabetic retinopathy is a chronic complication of diabetes that can result in blindness. Generally, there are two stages of diabetic retinopathy, non-proliferative and proliferative. The longer a person has diabetes and the poorer metabolic control, the higher the chance of developing diabetic retinopathy. The majority of people with type 2 diabetes will ultimately develop diabetic retinopathy. Multifactorial therapy targeted to lifestyle modification and optional glycemic control reduces the risk. However, diabetic retinopathy develops or progresses with time. Primary (preventive) strategies include glycemic, lipid, and blood pressure control. Glycemic control effectively reduces the incidence of diabetic retinopathy. In additional, its effect on progression of diabetic retinopathy has been demonstrated in randomized clinical trials. Furthermore, tight control of blood pressure significantly reduces the progression of retinopathy and visual loss. However, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study Group has shown that intensive blood pressure control has no beneficial effect on reducing the rate of diabetic retinopathy in subjects with type 2 diabetes. Elevated serum lipids and dyslipidemias are associated with a higher risk of diabetic retinopathy. The beneficial effects of lipid-lowering agents on the progression of retinopathy have been reported. Intensive combination therapy for dyslipidemia has been shown to effectively reduce the rate of progression of diabetic retinopathy in type 2 diabetes. Secondary strategies are focused on various pathophysiologic approaches such as blockade of the renin angiotensin system (RAS), anti-vascular endothelial growth factor agents, somatostatin analogues, protein kinase inhibitors, and anti-inflammatory agents. The purpose of the current overview is to look into the medical management of diabetic retinopathy, and to explore the primary (preventive) measures as well as secondary strategies proposed to be effective in its medical management.
糖尿病是一个全球性的健康问题，影响了全世界 3.66 亿人，其患病率正在迅速增长。多达 25%的糖尿病患者患有糖尿病眼病。糖尿病视网膜病变是糖尿病的一种慢性并发症，可导致失明。一般来说，糖尿病视网膜病变有两个阶段，非增殖性和增殖性。一个人患糖尿病的时间越长，代谢控制越差，患糖尿病视网膜病变的机会就越高。大多数 2 型糖尿病患者最终会发展为糖尿病视网膜病变。针对生活方式改变和可选血糖控制的多因素治疗可降低风险。然而，糖尿病视网膜病变会随着时间的推移而发展或进展。主要（预防）策略包括血糖、血脂和血压控制。血糖控制可有效降低糖尿病视网膜病变的发生率。此外，随机临床试验已经证明了其对糖尿病视网膜病变进展的影响。此外，严格控制血压可显著减缓视网膜病变和视力丧失的进展。然而，心血管风险控制行动（ACCORD）眼科研究小组表明，强化血压控制对 2 型糖尿病患者的糖尿病视网膜病变发生率没有有益影响。血清脂质升高和血脂异常与糖尿病视网膜病变风险增加有关。降脂药物对视网膜病变进展的有益作用已有报道。强化血脂联合治疗已被证明可有效降低 2 型糖尿病患者糖尿病视网膜病变的进展速度。二级策略侧重于各种病理生理方法，如肾素-血管紧张素系统（RAS）阻断、抗血管内皮生长因子药物、生长抑素类似物、蛋白激酶抑制剂和抗炎药物。目前综述的目的是探讨糖尿病视网膜病变的医学管理，并探讨被认为对其医学管理有效的主要（预防）措施和二级策略。
