Abu El-Asrar Ahmed M, Al-Mezaine Hani S
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Saudi J Ophthalmol. 2011 Apr;25(2):113-22. doi: 10.1016/j.sjopt.2011.01.005. Epub 2011 Jan 28.
Diabetic retinopathy, the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic macular edema and are an effective adjunctive treatments to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, pharmacologic vitreolysis, rennin-angiotensin system blockers, and peroxisome proliferator-activated receptor gamma agonists.
糖尿病视网膜病变是糖尿病最常见的长期并发症，仍是全球失明的主要原因之一。严格的代谢控制、严格的血压控制、激光光凝和玻璃体切除术仍是糖尿病视网膜病变的标准治疗方法。对于糖尿病性黄斑水肿患者，局灶性/格栅样光凝比玻璃体内注射曲安奈德是更好的治疗方法，应被视为一线治疗选择。目前的证据表明，玻璃体内注射曲安奈德或抗血管内皮生长因子药物可使难治性糖尿病性黄斑水肿患者的视力暂时改善，中心黄斑厚度短期降低，是激光光凝或玻璃体切除术的有效辅助治疗方法。然而，曲安奈德与眼压升高和白内障的风险相关。不进行内界膜剥除的玻璃体后皮质剥除玻璃体切除术似乎对持续性弥漫性糖尿病性黄斑水肿患者有效，尤其是伴有玻璃体黄斑牵拉的患者。新兴的治疗方法包括胰岛细胞移植、非诺贝特、鲁比前列酮、药物性玻璃体溶解、肾素-血管紧张素系统阻滞剂和过氧化物酶体增殖物激活受体γ激动剂。
