Elkjaer Anna Sofie, Lynge Sidsel Kirstine, Grauslund Jakob
Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Acta Ophthalmol. 2020 Jun;98(4):329-336. doi: 10.1111/aos.14377. Epub 2020 Feb 26.
Eye screening is mandatory in diabetes, but treatment is only indicated at the sight-threatening stages of diabetic retinopathy (DR). Treatments include intravitreal injections, laser photocoagulation and vitrectomy, which are all invasive options. In order to prevent or delay DR, it is important to investigate earlier, non-invasive managements prior to sight-threatening DR. The aim of this study is to evaluate the effect of systemic treatment on incident and progressive DR. The search in this systematic review was performed in PubMed and Embase using the keywords 'diabetic retinopathy' AND 'systemic therapy'. Two independent researchers identified 619 studies; 26 duplicates were removed, 579 articles were excluded based on title and abstract, and six were removed after full-text assessment. Five articles were added from reference screening, resolving in a total of 13 eligible articles. These were quality-assessed using the Cochrane Risk of Bias tool. Twelve randomized control trials and one follow-up study were included. Intensive glycaemic control (IGC), antihypertensive and lipid-lowering treatments were some of the main interventions tested in the studies. Three studies found statistically significant reduction of progression of DR by IGC, three by antihypertensive, and two by the lipid-lowering drug fenofibrate. Systemic intervention appears important in different stages of DR. While IGC seems effective in relation to incident and progressive DR, antihypertensive treatments may be valuable in the early stages of DR, as opposed to fenofibrate, which could benefit at a later stage.
糖尿病患者必须进行眼部筛查，但仅在糖尿病视网膜病变（DR）的威胁视力阶段才进行治疗。治疗方法包括玻璃体内注射、激光光凝和玻璃体切除术，这些都是侵入性的选择。为了预防或延缓DR，在DR威胁视力之前研究早期的非侵入性管理方法很重要。本研究的目的是评估全身治疗对新发和进展性DR的影响。在本系统评价中，使用关键词“糖尿病视网膜病变”和“全身治疗”在PubMed和Embase中进行检索。两名独立研究人员识别出619项研究；去除26项重复研究，基于标题和摘要排除579篇文章，全文评估后再排除6篇。通过参考文献筛选又补充了5篇文章，最终共有13篇符合条件的文章。使用Cochrane偏倚风险工具对这些文章进行质量评估。纳入了12项随机对照试验和1项随访研究。强化血糖控制（IGC）、抗高血压和降脂治疗是这些研究中测试的一些主要干预措施。三项研究发现IGC能使DR进展有统计学意义的降低，三项研究发现抗高血压治疗有此效果，两项研究发现降脂药物非诺贝特能使DR进展降低。全身干预在DR的不同阶段似乎都很重要。虽然IGC在新发和进展性DR方面似乎有效，但抗高血压治疗在DR早期可能有价值，而非诺贝特则可能在后期有益。
