Tomić Martina, Vrabec Romano, Poljičanin Tamara, Ljubić Spomenka, Duvnjak Lea
Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
Croatian National Institute of Public Health
Acta Clin Croat. 2017 Mar;56(1):124-132. doi: 10.20471/acc.2017.56.01.18.
Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide.
糖尿病是全球主要的公共卫生问题之一。糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的主要原因。理想的糖尿病代谢控制是治疗的主要目标，也是预防和阻止DME进展的基本方法。尽管激光光凝近三十年来一直是DME的标准治疗方法，但新型玻璃体内抗VEGF和类固醇疗法可取得更好的疗效。DME的新型治疗方案取决于基于光学相干断层扫描的视力以及黄斑增厚的位置/范围。根据国际临床分类标准，DME分为非中心累及性DME和中心累及性DME（CI-DME）。新指南推荐玻璃体内治疗作为CI-DME和中度视力损害患者的首选治疗方法。非CI-DME和轻度视力损害患者应采用改良的ETDRS激光光凝治疗并密切观察。玻璃体切除术是有DME牵引成分患者的首选治疗方法。如今，DME患者预防失明的传统治疗目标已被旨在恢复受损视力、防止进一步视力丧失和改善视觉功能的新目标所取代。因此，全球范围内正在进行许多针对这一新概念的试验。
