Ziemssen F, Lemmen K, Bertram B, Hammes H P, Agostini H
Department für Augenheilkunde, Eberhards-Karl-Universität Tübingen, Schleichstr. 12, 72076, Tübingen, Deutschland.
Augenarztpraxis Düsseldorf, Düsseldorf, Deutschland.
Ophthalmologe. 2016 Jul;113(7):623-38. doi: 10.1007/s00347-016-0315-8.
The updated German clinical practice guidelines (second edition) describe the consensus recommendations for prevention and treatment of retinal complications secondary to diabetes. According to the updated numbers on epidemiology a further increase of persons affected is expected. The prevalence of diabetic retinopathy is estimated to be 9-16 % in type 2 diabetes and 24-27 % in type 1 diabetes. A prolongation of the screening interval from 1 to 2 years is recommended for those patients with a lower risk of progression, when retinopathy has not already occurred and no increased systemic risk factors are present. Standardized documentation forms are the foundation for improved communication between the disciplines. If diabetic retinopathy is present, control examinations follow the stipulations of the ophthalmologist. The guidelines define scenarios when the use of optical coherence tomography (OCT) is necessary, e. g. diagnosis and follow-up of macular edema. Besides focal and panretinal laser therapy, the efficacy and risks of intravitreal operative pharmacotherapy are discussed. Focal laser coagulation is recommended for therapy of macular edema without foveal involvement and for macular edema with foveal involvement patients should be informed about the effective alternative forms of treatment. Panretinal laser coagulation is recommended for first line treatment of proliferative diabetic retinopathy and is optional for severe non-proliferative retinopathy.
最新版德国临床实践指南（第二版）阐述了糖尿病继发视网膜并发症的预防和治疗的共识性建议。根据最新的流行病学数据，预计患病人数会进一步增加。2型糖尿病患者糖尿病视网膜病变的患病率估计为9%-16%，1型糖尿病患者为24%-27%。对于那些病情进展风险较低、尚未发生视网膜病变且无全身性风险因素增加的患者，建议将筛查间隔从1年延长至2年。标准化的文档表格是改善各学科间沟通的基础。如果存在糖尿病视网膜病变，控制检查需遵循眼科医生的规定。该指南明确了需要使用光学相干断层扫描（OCT）的情况，例如黄斑水肿的诊断和随访。除了局部和全视网膜激光治疗外，还讨论了玻璃体内手术药物治疗的疗效和风险。对于未累及黄斑中心凹的黄斑水肿，推荐采用局部激光光凝治疗；对于累及黄斑中心凹的黄斑水肿，应告知患者有效的替代治疗方式。全视网膜激光光凝推荐用于增殖性糖尿病视网膜病变的一线治疗，对于严重非增殖性视网膜病变则为可选项。
