Berrocal and Associates in San Juan, San Juan, Puerto Rico.
Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
Curr Opin Ophthalmol. 2021 May 1;32(3):203-208. doi: 10.1097/ICU.0000000000000760.
Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment.
Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF.
Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.
糖尿病性视网膜病变（DR）是世界上导致可预防视力丧失的主要原因之一，其患病率在全球范围内持续上升。DR 的最终和致盲性并发症之一是增殖性糖尿病性视网膜病变（PDR）和随后的牵拉性视网膜脱离。治疗方式、手术技术以及对 DR 和 PDR 病理生理学的更好理解不断改变我们治疗疾病的方式。本文的目的是提供有关增殖性糖尿病性视网膜病变及其并发症（包括牵拉性视网膜脱离）的最新治疗方法和结果的更新。
全视网膜光凝（PRP）、抗血管内皮生长因子（anti-VEGF）和经睫状体平坦部玻璃体切除术是 PDR 治疗的主要方法。然而，PRP 和 anti-VEGF 与显著的治疗负担和多次后续治疗相关。与 PRP 和 anti-VEGF 治疗相比，早期玻璃体切除术与视力保存、更少的治疗负担和更少的后续治疗相关。
就成本而言，糖尿病患者的高不遵医嘱率和初始 PRP 和 anti-VEGF 治疗后的高后续治疗率，对于有 PDR 风险的糖尿病患者，早期玻璃体切除术是一种具有成本效益的长期稳定治疗方法，适用于晚期疾病患者。
