Tolentino Michael Steven, Tolentino Andrew John, Tolentino Michael John
a Department of Research , Center for Retina and Macular Disease , Winter Haven , FL , USA.
b Department of Ophthalmology , Univerisity of Central Florida , Orlando , FL , USA.
Expert Opin Investig Drugs. 2016 Sep;25(9):1011-22. doi: 10.1080/13543784.2016.1201062. Epub 2016 Jul 1.
Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are the two complications of diabetes that cause visual loss and blindness. Laser photo-coagulation in the past was used to prevent progression of disease to these advanced stages. Advances in pathophysiologic understanding of DME and PDR have ushered the development of effective targeted therapy that given intravitreally improves vision and prevents blindness. While effective, these therapies require frequent administration and are not universally effective.
This purpose of this paper is to review the current pathophysiologic understanding and treatments for DME and PDR as well as the novel treatments currently being developed. The treatments will be juxtaposed to the factor in the disease cascade being targeted. The potential role of these novel treatment in the clinical armamentarium are postulated.
Mono-therapy, single category targeting is the current strategy being utilized clinically. However, diabetic retinopathy needs combination therapy. Therapies that will prove successful will address multiple factors involved in the pathogenesis of diabetic retinopathy.
糖尿病性黄斑水肿(DME)和增殖性糖尿病视网膜病变(PDR)是糖尿病导致视力丧失和失明的两种并发症。过去曾使用激光光凝术来预防疾病进展至这些晚期阶段。对DME和PDR病理生理学认识的进展推动了有效的靶向治疗的发展,玻璃体内注射这种治疗可改善视力并预防失明。虽然这些治疗有效,但需要频繁给药且并非对所有患者都有效。
本文旨在综述目前对DME和PDR的病理生理学认识及治疗方法,以及正在研发的新型治疗方法。这些治疗方法将与疾病级联反应中所针对的因素并列阐述。推测了这些新型治疗方法在临床治疗手段中的潜在作用。
单一疗法、单类别靶向是目前临床采用的策略。然而,糖尿病视网膜病变需要联合治疗。成功的治疗方法将针对糖尿病视网膜病变发病机制中涉及的多个因素。