NIHR Biomedical Research Centre at Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Diabet Med. 2013 Jun;30(6):640-50. doi: 10.1111/dme.12089.
Decades of research into the pathophysiology and management of diabetic retinopathy have revolutionized our understanding of the disease process. Diabetic retinopathy is now more accurately defined as a neurovascular rather than a microvascular disease as neurodegenerative disease precedes and coexists with microvascular changes. However, the complexities of the pathways involved in different stages of disease severity continue to remain a challenging issue for drug discovery. Currently, laser photocoagulation is the mainstay of treatment for proliferative diabetic retinopathy, but is gradually being superseded for diabetic macular oedema. However, it is destructive and at best results in a gradual but modest improvement in vision in the long term. So, diabetic retinopathy remains the most prevalent cause of visual impairment in the working-age population despite established screening programmes, early diagnosis and treatment of the condition. The recent discovery of inhibitors of vascular endothelial growth factor is revolutionizing the management of diabetic retinopathy, particularly diabetic macular oedema. However, not all patients respond to anti-vascular endothelial growth factor agents, reinforcing the fact that diabetic retinopathy is a multifactorial disease. Studies are still required to improve our understanding of how retinal structure correlates with visual function. It is hoped that these will lead to better characterization of the disease phenotype based on treatment responses to different agents and allow an algorithm to be developed that will guide the management of diabetic retinopathy and diabetic macular oedema at different stages of severity.
几十年来，对糖尿病视网膜病变的病理生理学和治疗的研究彻底改变了我们对疾病过程的认识。糖尿病视网膜病变现在更准确地定义为神经血管疾病，而不是微血管疾病，因为神经退行性疾病先于微血管变化发生并与之共存。然而，不同疾病严重程度阶段涉及的途径的复杂性仍然是药物发现的一个具有挑战性的问题。目前，激光光凝是治疗增生性糖尿病性视网膜病变的主要方法，但逐渐被糖尿病性黄斑水肿所取代。然而，它具有破坏性，从长远来看，最多只能导致视力逐渐但适度改善。因此，尽管有既定的筛查计划、早期诊断和治疗，糖尿病视网膜病变仍然是工作年龄人群中最常见的视力损害原因。血管内皮生长因子抑制剂的最近发现彻底改变了糖尿病视网膜病变的治疗方法，特别是糖尿病性黄斑水肿。然而，并非所有患者对抗血管内皮生长因子药物都有反应，这一事实强化了糖尿病视网膜病变是一种多因素疾病的观点。仍需要研究来提高我们对视网膜结构与视觉功能之间相关性的理解。希望这些研究将有助于更好地根据对不同药物的治疗反应来描述疾病表型，并开发一种算法来指导不同严重程度的糖尿病性视网膜病变和糖尿病性黄斑水肿的管理。
