a Department of Ophthalmology , Mayo Clinic Florida , Jacksonville , FL , USA.
b Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , FL , USA.
Expert Opin Drug Deliv. 2016 Sep;13(9):1277-87. doi: 10.1080/17425247.2016.1198771. Epub 2016 Jun 22.
Intraocular pharmacotherapy (vascular endothelial growth factor [VEGF] inhibitors and corticosteroids) has become first-line therapy for diabetic retinopathy (DR). A series of intraocular injections is usually required before disease modulation decreases the treatment burden in some patients, but others with chronic diabetic macular edema may require intensive longer-term therapy.
Recent studies showing successful pharmacologic treatment of proliferative DR will probably lead to increased use of pharmacotherapy, thereby further emphasizing the need for longer duration drugs. Recently approved anti-VEGF drugs (aflibercept) and corticosteroids (dexamethasone and fluocinolone inserts) provide extended durations of action. Longer action anti-VEGF molecules, sustained release devices and pumps, and encapsulated cell technology, may further decrease treatment burden, though regulatory approval may not occur for at least 5 years. Oral medications (danazol and minocycline) and modified topical drugs (loteprednol) will require daily administration but may decrease the frequency of visits to physicians' offices. Intravitreally administered drugs that target different biochemical pathways are being developed as monotherapy and combination therapy, and their effects on durability remains to be seen.
The rich development pipeline promises to provide improved therapeutic options in addition to drugs and devices with longer duration of action.
眼内药物治疗（血管内皮生长因子 [VEGF] 抑制剂和皮质类固醇）已成为糖尿病视网膜病变（DR）的一线治疗方法。在疾病调节降低某些患者的治疗负担之前，通常需要进行一系列眼内注射，但其他患有慢性糖尿病性黄斑水肿的患者可能需要强化的长期治疗。
最近的研究表明，增殖性 DR 的药物治疗取得了成功，这可能会导致更多地使用药物治疗，从而进一步强调需要更长期的药物。最近批准的抗 VEGF 药物（阿柏西普）和皮质类固醇（地塞米松和氟轻松插入物）提供了更长的作用时间。更长作用时间的抗 VEGF 分子、缓释装置和泵以及封装细胞技术可能会进一步降低治疗负担，但至少在 5 年内可能不会获得监管批准。口服药物（达那唑和米诺环素）和改良的局部药物（洛替泼诺）需要每天给药，但可能会减少去医生办公室的就诊次数。正在开发针对不同生化途径的眼内给药药物作为单一疗法和联合疗法，其对持久性的影响仍有待观察。
丰富的研发渠道有望提供除具有更长作用时间的药物和装置之外的改善治疗选择。
