Barham Rasha, El Rami Hala, Sun Jennifer K, Silva Paolo S
a Beetham Eye Institute, Joslin Diabetes Center , Boston , MA , USA.
b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA.
Semin Ophthalmol. 2017;32(1):56-66. doi: 10.1080/08820538.2016.1228388.
Diabetes mellitus is a chronic disease that affects 415 million people worldwide. Despite treatment advances, diabetic eye disease remains a leading cause of vision loss worldwide. Diabetic macular edema (DME) is a common cause of vision loss in diabetic patients. The pathophysiology is complex and involves multiple pathways that ultimately lead to central retinal thickening and, if untreated, visual loss. First-line treatment of DME has evolved from focal/grid laser established by the Early Treatment of Diabetic Retinopathy Study (ETDRS) to intravitreous pharmacologic therapy. Landmark prospective clinical trials examining the effect of intravitreous injections of vascular endothelial growth factor (VEGF) inhibitors in the treatment of DME have demonstrated improved visual outcomes over focal grid laser. This review focuses on the scientific evidence treatment of DME, disease pathophysiology, clinical disease course, current treatment standards, and emerging novel therapeutic approaches.
糖尿病是一种影响全球4.15亿人的慢性疾病。尽管治疗取得了进展，但糖尿病眼病仍是全球视力丧失的主要原因。糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的常见原因。其病理生理学很复杂，涉及多个途径，最终导致视网膜中央增厚，若不治疗则会导致视力丧失。DME的一线治疗已从糖尿病视网膜病变早期治疗研究（ETDRS）确立的局部/格栅激光治疗发展到玻璃体内药物治疗。多项具有里程碑意义的前瞻性临床试验研究了玻璃体内注射血管内皮生长因子（VEGF）抑制剂治疗DME的效果，结果表明与局部格栅激光治疗相比，其视力预后有所改善。本综述重点关注DME治疗的科学证据、疾病病理生理学、临床病程、当前治疗标准以及新兴的新型治疗方法。
