Wykoff Charles C
Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Greater Houston Retina Research Foundation, Weill Cornell Medical College, Houston, Texas, USA.
Curr Opin Ophthalmol. 2017 May;28(3):213-218. doi: 10.1097/ICU.0000000000000364.
Diabetic retinopathy is common and increasing in prevalence. Pharmacologic management of diabetic macular edema (DME) has improved tremendously over the last decade with the use of two families of intravitreally administered medications: antivascular endothelial growth factor-specific agents and corticosteroids. Clinical evaluation of these pharmaceuticals has demonstrated that they can have a substantial impact on diabetic retinopathy severity levels and the underlying retinal vasculature itself.
Phase 3 trials employing ranibizumab, aflibercept, and fluocinolone acetonide enrolling eyes with center-involving DME causing visual acuity loss have demonstrated impressive alteration of the natural history of progressive diabetic retinopathy worsening over time through blunted progression to proliferative diabetic retinopathy, improving diabetic retinopathy severity levels, and slowing progressive retinal nonperfusion, the underlying disease process central to diabetic retinopathy itself.
Accumulating data indicate that the threshold to initiate ocular-specific pharmacologic treatment for diabetic retinopathy, previously predominately limited to eyes with visual loss because of center-involved DME or proliferative diabetic retinopathy, is being lowered to earlier stages of diabetic retinopathy. Ongoing clinical trials and secondary analyses continue to further explore the impact and durability of vascular endothelial growth factor blockade and corticosteroids on modification of diabetic retinopathy and the underlying retinal vasculature itself.
糖尿病视网膜病变很常见，且患病率不断上升。在过去十年中，随着两类玻璃体内注射药物（抗血管内皮生长因子特异性药物和皮质类固醇）的使用，糖尿病性黄斑水肿（DME）的药物治疗有了巨大改善。对这些药物的临床评估表明，它们可对糖尿病视网膜病变的严重程度及视网膜血管系统本身产生重大影响。
采用雷珠单抗、阿柏西普和醋酸氟轻松的3期试验纳入了因累及中心凹的DME导致视力丧失的眼睛，结果显示，随着时间推移，进展性糖尿病视网膜病变自然病程发生了显著改变，通过延缓向增殖性糖尿病视网膜病变的进展、改善糖尿病视网膜病变严重程度以及减缓视网膜进行性无灌注（糖尿病视网膜病变本身的核心潜在疾病过程）。
越来越多的数据表明，糖尿病视网膜病变眼部特异性药物治疗的起始阈值正在降低至糖尿病视网膜病变的早期阶段，此前该治疗主要限于因累及中心凹的DME或增殖性糖尿病视网膜病变而视力丧失的眼睛。正在进行的临床试验和二次分析继续进一步探索血管内皮生长因子阻断和皮质类固醇对糖尿病视网膜病变及视网膜血管系统本身改变的影响和持久性。
