糖尿病视网膜并发症的防治
The Prevention and Treatment of Retinal Complications in Diabetes.
作者信息
Schorr Susanne Gabriele, Hammes Hans-Peter, Müller Ulrich Alfons, Abholz Heinz-Harald, Landgraf Rüdiger, Bertram Bernd
机构信息
German Agency for Quality in Medicine (ÄZQ), Berlin.
出版信息
Dtsch Arztebl Int. 2016 Dec 2;113(48):816-823. doi: 10.3238/arztebl.2016.0816.
BACKGROUND
Microvascular complications of diabetes mellitus can cause retino pathy and maculopathy, which can irreversibly damage vision and lead to blindness. The prevalence of retinopathy is 9-16% in patients with type 2 diabetes and 24-27% in patients with type 1 diabetes. 0.2-0.5% of diabetics are blind.
METHODS
The National Disease Management Guideline on the prevention and treatment of retinal complications in diabetes was updated according to recommendations developed by seven scientific medical societies and organizations and by patient representatives and then approved in a formal consensus process. These recommendations are based on international guidelines and systematic reviews of the literature.
RESULTS
Regular ophthalmological examinations enable the detection of retinopathy in early, better treatable stages. The control intervals should be based on the individual risk profile: 2 years for low-risk patients and 1 year for others, or even shorter depending on the severity of retinopathy. General risk factors for retinopathy include the duration of diabetes, the degree of hyperglycemia, hypertension, and diabetic nephropathy. The general, individually adapted treatment strategies are aimed at improving the risk profile. The most important specifically ophthalmological treatment recommendations are for panretinal laser coagulation in proliferative diabetic retinopathy and, in case of clinically significant diabetic macular edema with foveal involvement, for the intravitreal application of medications (mainly, vascular endothelial growth factor [VEGF] inhibitors), if an improvement of vision with this treatment is thought to be possible.
CONCLUSION
Regular, risk-adapted ophthalmological examinations, with standardized documentation of the findings for communication between ophthalmologists and the patients' treating primary care physicians/diabetologists, is essential for the prevention of diabetic retinal complications, and for their optimal treatment if they are already present.
背景
糖尿病微血管并发症可导致视网膜病变和黄斑病变，会对视力造成不可逆转的损害并导致失明。2型糖尿病患者中视网膜病变的患病率为9%-16%，1型糖尿病患者中为24%-27%。0.2%-0.5%的糖尿病患者失明。
方法
根据七个科学医学协会、组织以及患者代表提出的建议，对糖尿病视网膜并发症防治的国家疾病管理指南进行了更新，随后在正式的共识过程中获得批准。这些建议基于国际指南和文献系统评价。
结果
定期眼科检查能够在视网膜病变的早期、更易治疗阶段进行检测。检查间隔应根据个体风险状况确定：低风险患者为2年，其他患者为1年，或根据视网膜病变的严重程度甚至更短。视网膜病变的一般风险因素包括糖尿病病程、高血糖程度、高血压和糖尿病肾病。一般的、根据个体情况调整的治疗策略旨在改善风险状况。最重要的眼科具体治疗建议是，对于增殖性糖尿病视网膜病变进行全视网膜激光光凝治疗，对于累及黄斑中心凹的具有临床意义的糖尿病黄斑水肿，若认为该治疗可能改善视力，则进行玻璃体内药物注射（主要是血管内皮生长因子[VEGF]抑制剂）。
结论
定期进行根据风险调整的眼科检查，并对检查结果进行标准化记录，以便眼科医生与患者的初级保健医生/糖尿病专科医生之间进行沟通，这对于预防糖尿病视网膜并发症以及在并发症已经出现时进行最佳治疗至关重要。
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