Terasaki Hiroko, Ogura Yuichiro, Kitano Shigehiko, Sakamoto Taiji, Murata Toshinori, Hirakata Akito, Ishibashi Tatsuro
Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Jpn J Ophthalmol. 2018 Jan;62(1):1-23. doi: 10.1007/s10384-017-0537-6. Epub 2017 Dec 5.
Diabetic retinopathy is a frequent cause of visual impairment in working-age adults (≥ 30 years) and in Japan is most commonly observed in those aged 50-69 years. Diabetic macular edema (DME) is one of the main causes of vision disturbance in diabetic retinopathy, which is a clinically significant microvascular complication of diabetes. Anti-vascular endothelial growth factor (VEGF) therapy is becoming the mainstay of treatment for DME. However, to achieve sustained long-term improvement in visual acuity, conventional laser photocoagulation, vitrectomy and steroid therapy are also expected to play a role in the treatment of DME. This review summarizes the epidemiology and pathology of diabetic retinopathy and DME, evaluates the findings regarding the diagnosis and treatment of DME, and underscores the importance of systemic management of the disease in the context of the current health care situation in Japan. Finally, the unmet needs of patients with DME and prospects for research are discussed. The weight of evidence suggests that it is important to establish a multipronged treatment strategy centered on anti-VEGF therapy.
糖尿病性视网膜病变是工作年龄成年人（≥30岁）视力损害的常见原因，在日本最常见于50 - 69岁的人群。糖尿病性黄斑水肿（DME）是糖尿病性视网膜病变中视力障碍的主要原因之一，糖尿病性视网膜病变是糖尿病临床上一种重要的微血管并发症。抗血管内皮生长因子（VEGF）治疗正成为DME治疗的主要手段。然而，为了实现视力的持续长期改善，传统的激光光凝、玻璃体切除术和类固醇治疗也有望在DME的治疗中发挥作用。本综述总结了糖尿病性视网膜病变和DME的流行病学和病理学，评估了关于DME诊断和治疗的研究结果，并强调了在日本当前医疗保健背景下对该疾病进行系统管理的重要性。最后，讨论了DME患者未满足的需求和研究前景。大量证据表明，建立以抗VEGF治疗为中心的多管齐下的治疗策略很重要。
