Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore.
Beetham Eye Institute, Joslin Diabetes Center, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Ophthalmology. 2018 Oct;125(10):1608-1622. doi: 10.1016/j.ophtha.2018.04.007. Epub 2018 May 24.
Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.
糖尿病(DM)是一种全球性的流行病,影响着发展中国家和发达国家的人群,这些国家的医疗保健和资源水平存在差异。糖尿病视网膜病变(DR)是 DM 的主要并发症,也是工作中年成年人视力丧失的主要原因。通过广泛的公共卫生策略可以预防 DR 导致的视力丧失,但这些策略需要根据一个国家和人群的资源情况进行调整。设计 DR 筛查计划,将患者及时转诊至有专业眼科医护人员的医疗机构,并对威胁视力的 DR 进行具有成本效益的治疗,可以预防视力丧失。2017 年国际眼科理事会糖尿病眼病护理指南总结并为 DR 筛查、转诊和随访计划以及威胁视力的 DR 的适当管理(包括糖尿病性黄斑水肿[DME]和增生性 DR)提供了全面的指导,适用于高、低或中等资源设置的国家。指南包括关于筛查和转诊标准的最新证据、筛查视力和视网膜检查的最低要求、随访护理以及 DR 和 DME 的管理,包括激光光凝以及血管内皮生长因子抑制剂的适当使用,在特定情况下还包括眼内皮质类固醇。还包括了对妊娠期间和并发白内障的 DR 患者管理的建议。该指南还提出了监测人群水平结果和成功指标的建议。