Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
Surv Ophthalmol. 2013 Sep-Oct;58(5):459-65. doi: 10.1016/j.survophthal.2012.10.002.
Recent clinical trials have changed the management paradigm for diabetic macular edema (DME). There is an urgent need to identify the most effective ways of preventing retinopathy or intervening at an early, asymptomatic stage in order to preserve vision. The rise in the incidence of diabetes is a serious public health concern. Grading and screening programmes help to identify sight threatening diabetic retinopathy in the community early and facilitate timely referral to an ophthalmologist. Systemic therapies for DME target the key modifiable risk factors: metabolic and blood pressure control. There may also be a role for modification of the renin-angiotensin system and for lipid lowering agents. Improved glycemic and blood pressure control remain the most effective ways of reducing morbidity from DME. Fenofibrate also has beneficial effects, but the mechanism for this remains unclear. Multiple new treatments are in the pipeline, and these are expected to change our approach to DME for the first time in 30 years.
最近的临床试验改变了糖尿病性黄斑水肿（DME）的治疗模式。为了保护视力，迫切需要确定预防视网膜病变或在早期无症状阶段进行干预的最有效方法。糖尿病发病率的上升是一个严重的公共卫生问题。分级和筛查计划有助于在社区早期发现威胁视力的糖尿病性视网膜病变，并为及时转介给眼科医生提供便利。DME 的全身治疗针对的是关键的可改变的危险因素：代谢和血压控制。肾素-血管紧张素系统的改变和降脂药也可能有作用。改善血糖和血压控制仍然是减少 DME 发病率的最有效方法。非诺贝特也有有益的效果，但机制尚不清楚。多种新的治疗方法正在研发中，预计这将首次改变我们对 DME 的治疗方法，这一变化已经等待了 30 年。
