Academic Ophthalmology and Vision Sciences, Division of Clinical Neurosciences, Eye and ENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Ophthalmology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Eye (Lond). 2020 Jun;34(Suppl 1):1-51. doi: 10.1038/s41433-020-0961-6.
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
糖尿病性视网膜病变（DR）的管理在过去十年中发生了重大变化，新的技术（诊断和治疗）不断涌现。因此，现有的皇家眼科医师学院 DR 指南（2013 年）已经过时，据我们所知，目前这些指南并没有修订。此外，英国没有其他指南涵盖所有可用的治疗方法，而且在英国，糖尿病性黄斑水肿（DMO）的管理方法存在很大差异。本文总结了 DR 和 DMO 的发病机制的综述，包括血管内皮生长因子（VEGF）和非 VEGF 细胞因子的作用、DMO 的临床分级/分类与当前术语（中心累及[CI-DMO]或非中心累及[nCI-DMO]、全身风险及其管理）。英国优秀的 DR 筛查（DRS）服务不断发展，仍然处于世界领先地位。然而，仍然存在挑战，因为在全国范围内，设备的使用存在很大差异，并且 DMO 筛查的重复性标准也存在差异。DRS 与医院眼科服务之间的过渡期只能通过进一步的改进来加强。讨论了现代技术（包括光学相干断层扫描[OCT]和广角成像）和工作实践（包括虚拟诊所及其在增加诊所容量、改善患者体验和结果方面的潜力）的作用。同样，探讨了未来在糖尿病眼中进行家庭监测的潜在作用。总结了药物治疗（玻璃体内注射抗 VEGF 和皮质类固醇）和激光治疗的作用。一般来说，玻璃体内注射抗 VEGF 被作为一线药物治疗。由于特定患者群体（包括孕妇、儿童和学习困难者）的糖尿病患者的需求可能有所不同，因此在这些特定患者群体中，DR 管理需要个性化。在这些情况下，首选治疗需要个体化，可能是玻璃体内皮质类固醇而不是标准选择的抗 VEGF 药物。本文讨论了其中的一些，但不是全部。
