Kusuhara Sentaro, Fukushima Yoko, Ogura Shuntaro, Inoue Naomi, Uemura Akiyoshi
Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
Diabetes Metab J. 2018 Oct;42(5):364-376. doi: 10.4093/dmj.2018.0182.
Vision loss in diabetic retinopathy (DR) is ascribed primarily to retinal vascular abnormalities-including hyperpermeability, hypoperfusion, and neoangiogenesis-that eventually lead to anatomical and functional alterations in retinal neurons and glial cells. Recent advances in retinal imaging systems using optical coherence tomography technologies and pharmacological treatments using anti-vascular endothelial growth factor drugs and corticosteroids have revolutionized the clinical management of DR. However, the cellular and molecular mechanisms underlying the pathophysiology of DR are not fully determined, largely because hyperglycemic animal models only reproduce limited aspects of subclinical and early DR. Conversely, non-diabetic mouse models that represent the hallmark vascular disorders in DR, such as pericyte deficiency and retinal ischemia, have provided clues toward an understanding of the sequential events that are responsible for vision-impairing conditions. In this review, we summarize the clinical manifestations and treatment modalities of DR, discuss current and emerging concepts with regard to the pathophysiology of DR, and introduce perspectives on the development of new drugs, emphasizing the breakdown of the blood-retina barrier and retinal neovascularization.
糖尿病视网膜病变（DR）导致的视力丧失主要归因于视网膜血管异常，包括高通透性、灌注不足和新生血管形成，这些最终会导致视网膜神经元和神经胶质细胞发生解剖学和功能改变。利用光学相干断层扫描技术的视网膜成像系统以及使用抗血管内皮生长因子药物和皮质类固醇的药物治疗方面的最新进展，彻底改变了DR的临床管理。然而，DR病理生理学的细胞和分子机制尚未完全明确，这主要是因为高血糖动物模型仅再现了亚临床和早期DR的有限方面。相反，代表DR标志性血管疾病（如周细胞缺乏和视网膜缺血）的非糖尿病小鼠模型，为理解导致视力损害状况的一系列事件提供了线索。在本综述中，我们总结了DR的临床表现和治疗方式，讨论了关于DR病理生理学的当前和新兴概念，并介绍了新药开发的观点，重点强调血视网膜屏障的破坏和视网膜新生血管形成。
