CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas) and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, Universitat de Barcelona, L'Hospitalet del LLobregat, Barcelona, Spain.
J Endocrinol Invest. 2017 Sep;40(9):925-935. doi: 10.1007/s40618-017-0648-4. Epub 2017 Mar 29.
Diabetic retinopathy (DR) is the leading cause of visual impairment and preventable blindness and represents a significant socioeconomic cost for healthcare systems worldwide. In early stages of DR the only therapeutic strategy that physicians can offer is a tight control of the risk factors for DR (mainly blood glucose and blood pressure). The currently available treatments for DR are applicable only at advanced stages of the disease and are associated with significant adverse effects. Therefore, new treatments for the early stages of DR are needed. However, in early stages of DR invasive treatments such as intravitreal injections are too aggressive, and topical treatment seems to be an emerging route. In the present review, therapeutic strategies based on the main pathogenic mechanisms involved in the development of DR are reviewed. The main gap in the clinical setting is the treatment of early stages of DR and, therefore, this review emphasizes in this issue by giving an overview of potential druggable targets. By understanding of disease-specific pathogenic mechanisms, biological heterogeneity and progression patterns in early and advanced DR a more personalised approach to patient treatment will be implemented.
糖尿病视网膜病变（DR）是全球导致视力损害和可预防失明的主要原因，也是对医疗保健系统造成重大社会经济负担的原因。在 DR 的早期阶段，医生唯一能提供的治疗策略是严格控制 DR 的风险因素（主要是血糖和血压）。目前用于 DR 的治疗方法仅适用于疾病的晚期阶段，并且会伴随显著的不良反应。因此，需要针对 DR 的早期阶段开发新的治疗方法。然而，在 DR 的早期阶段，侵入性治疗（如玻璃体内注射）过于激进，而局部治疗似乎是一种新兴途径。在本次综述中，我们回顾了基于 DR 发展过程中涉及的主要发病机制的治疗策略。临床实践中的主要差距是 DR 早期阶段的治疗，因此，本综述通过概述潜在的可用药靶来强调这一问题。通过了解疾病特异性发病机制、生物异质性以及早期和晚期 DR 的进展模式，可以对患者的治疗采取更具个性化的方法。
