Lingam Gopal, Wong Tien Yin
Department of ophthalmology, National University Health System, Singapore ; National University of Singapore, Singapore ; Singapore Eye Research Institute, Singapore.
Middle East Afr J Ophthalmol. 2013 Oct-Dec;20(4):301-8. doi: 10.4103/0974-9233.120010.
Diabetes mellitus (DM) has assumed epidemic proportions and as a consequence, diabetic retinopathy is expected to be a major societal problem across the world. Diabetic retinopathy (DR) affects the vision by way of proliferative disease that results in vitreous hemorrhage and traction retinal detachment or by way of diabetic maculopathy (DME). The present-day management of diabetic retinopathy revolves around screening the diabetics for evidence of retinopathy and treating the retinopathy with laser photocoagulation. DME is treated with laser photocoagulation and/or intra- vitreal injection of anti-vascular endothelial growth factor (VEGF) agents or steroids. Laser remains the mainstay of treatment and is potentially destructive. Systemic management aims at preventing or delaying the onset of retinopathy; reversing the early retinopathy; or delaying the progression of established retinopathy. Evidence from multiple studies has confirmed the protective role of rigid control of blood glucose and blood pressure. The evidence for lipid control versus maculopathy was less definitive. However, the use of fenofibrates (originally used for lowering serum lipids) has shown a benefit on both proliferative disease and maculopathy outside their lipid-lowering effect. Other drugs being tried are the Protein Kinase C (PKC) inhibitors, other peroxisome proliferator-activated receptors (PPAR) agonists, Forsoklin (which binds GLUT 1 receptor), minocycline (for its anti inflammatory effect), and Celecoxib (Cox-2 inhibitor).
糖尿病（DM）已呈流行态势，因此，糖尿病视网膜病变预计将成为全球一个主要的社会问题。糖尿病视网膜病变（DR）通过导致玻璃体出血和牵拉性视网膜脱离的增殖性疾病或通过糖尿病性黄斑病变（DME）影响视力。目前糖尿病视网膜病变的管理围绕筛查糖尿病患者是否有视网膜病变证据以及用激光光凝治疗视网膜病变展开。DME通过激光光凝和/或玻璃体内注射抗血管内皮生长因子（VEGF）药物或类固醇进行治疗。激光仍然是主要的治疗手段，且具有潜在破坏性。全身治疗旨在预防或延缓视网膜病变的发生；逆转早期视网膜病变；或延缓已确诊视网膜病变的进展。多项研究的证据证实了严格控制血糖和血压的保护作用。关于血脂控制与黄斑病变的证据不太明确。然而，使用非诺贝特（最初用于降低血脂）已显示出在其降脂作用之外对增殖性疾病和黄斑病变均有益处。正在试验的其他药物有蛋白激酶C（PKC）抑制剂、其他过氧化物酶体增殖物激活受体（PPAR）激动剂、福斯可林（与葡萄糖转运蛋白1受体结合）、米诺环素（因其抗炎作用）和塞来昔布（环氧化酶-2抑制剂）。
