Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
Diabetes Metab. 2019 Dec;45(6):517-527. doi: 10.1016/j.diabet.2019.04.002. Epub 2019 Apr 18.
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and the leading cause of visual impairment in the working-age population in the Western world. Diabetic macular oedema (DME) is one of the major complications of DR. Therapy with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs has become the gold standard treatment for DR and its complications. However, these drugs have no effect on the pathogenesis of DR and must be administered frequently via invasive intravitreal injections over many years. Thus, there is a pressing need to develop new therapeutic strategies to improve the treatment of this devastating disease. Indeed, an increasing volume of data supports the role of the inflammatory process in the pathogenesis of DR itself and its complications, including both increased retinal vascular permeability and neovascularization. Inflammation may also contribute to retinal neurodegeneration. Evidence that low-grade inflammation plays a critical role in the pathogenesis of DME has opened up new pathways and targets for the development of improved treatments. Anti-inflammatory compounds such as intravitreal glucocorticoids, topical non-steroidal anti-inflammatory drugs (NSAIDs), antioxidants, inflammatory molecule inhibitors, renin-angiotensin system (RAS) blockers and natural anti-inflammatory therapies may all be considered to reduce the rate of administration of antineovascularization agents in the treatment of DR. This report describes the current state of knowledge of the potential role of anti-inflammatory drugs in controlling the onset and evolution of DR and DME.
糖尿病性视网膜病变（DR）是糖尿病最常见的微血管并发症，也是西方世界工作年龄段人群视力损害的主要原因。糖尿病性黄斑水肿（DME）是 DR 的主要并发症之一。眼内注射抗血管内皮生长因子（anti-VEGF）药物的治疗已成为 DR 及其并发症的金标准治疗方法。然而，这些药物对 DR 的发病机制没有影响，必须通过多年多次侵入性眼内注射来频繁给药。因此，迫切需要开发新的治疗策略来改善这种破坏性疾病的治疗效果。事实上，越来越多的数据支持炎症过程在 DR 本身及其并发症的发病机制中的作用，包括视网膜血管通透性增加和新生血管形成。炎症也可能导致视网膜神经退行性变。低水平炎症在 DME 发病机制中起关键作用的证据为开发改进治疗方法开辟了新的途径和靶点。具有抗炎作用的药物，如眼内糖皮质激素、局部非甾体抗炎药（NSAIDs）、抗氧化剂、炎症分子抑制剂、肾素-血管紧张素系统（RAS）阻滞剂和天然抗炎疗法，都可以考虑用于减少 DR 治疗中抗新生血管药物的给药频率。本报告描述了抗炎药物在控制 DR 和 DME 发病和进展中的潜在作用的现有知识状态。
