Al Dhibi Hassan A, Arevalo J Fernando
Hassan A Al Dhibi, J Fernando Arevalo, Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia.
World J Diabetes. 2013 Dec 15;4(6):295-302. doi: 10.4239/wjd.v4.i6.295.
Diabetic macular edema (DME) is a common cause of visual impairment in diabetic patients. It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier. The pathogenesis of DME is multifactorial. Several therapeutic modalities have been proposed for the treatment of DME. Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities, due to anti-inflammatory, anti-vascular endothelial growth factor and anti-proliferative effects. Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME. Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease. Steroid-related side effects include elevated intraocular pressure, cataract, and injection related complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment particularly with intravitreal steroid injections. In order to reduce the risks, complications and frequent dosing of intravitreal steroids, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.
糖尿病性黄斑水肿（DME）是糖尿病患者视力损害的常见原因。它是由黄斑周围毛细血管通透性增加和血视网膜屏障破坏引起的。DME的发病机制是多因素的。已经提出了几种治疗DME的方法。由于具有抗炎、抗血管内皮生长因子和抗增殖作用，皮质类固醇治疗已成为持续性DME或对传统激光光凝及其他方法无效的DME的替代疗法。许多研究表明，皮质类固醇在短期治疗DME方面具有有益的治疗效果，可改善视网膜厚度和视力。由于该疾病具有慢性和复发性，球周注射和玻璃体内注射已被用于为DME递送类固醇，且注射频率较高。类固醇相关的副作用包括眼压升高、白内障以及注射相关并发症，如眼内炎、玻璃体积血和视网膜脱离，尤其是玻璃体内注射类固醇时。为了降低玻璃体内类固醇的风险、并发症和频繁给药，最近开发了玻璃体内植入物，以提供皮质类固醇的持续释放，并减少用于治疗DME的重复玻璃体内注射。
