2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
Department of Ophthalmology, Reference Center in Rare diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.
Eye (Lond). 2022 Apr;36(4):692-703. doi: 10.1038/s41433-021-01750-4. Epub 2021 Aug 18.
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in patients with DM. In the pathogenesis of DR, chronic hyperglycemia leads to biochemical and structural alterations in retinal blood vessels' wall, resulting in hyperpermeability and non-perfusion. Since vascular endothelial growth factor (VEGF) has been found to play a significant role in the pathogenesis of DR, this review sheds light on the effect of intravitreal anti-VEGF agents on retinal non-perfusion in patients with DR. Based on the existing literature, anti-VEGF agents have been shown to improve DR severity, although they cannot reverse retinal ischemia. The results of the published studies are controversial and differ based on the location of retinal non-perfusion, as well as the imaging modality used to assess retinal non-perfusion. In cases of macular non-perfusion, most of studies showed no change in both fundus fluorescein angiography (FFA) and optical coherence tomography (OCTA) in patients with DR treated with intravitreal anti-VEGF agents, while few studies reported worsening of non-perfusion with enlargement of foveal avascular zone (FAZ). Regarding peripheral ischemia, studies using wide-field-FFA demonstrated an improvement or stability in non-perfusion areas after anti-VEGF treatment. However, the use of wide-field-OCTA revealed no signs of re-perfusion of retinal vessels post anti-VEGF treatment. Further prospective studies with long follow-up and large sample size are still needed to draw solid conclusions.
糖尿病视网膜病变（DR）是糖尿病（DM）最常见的微血管并发症，也是 DM 患者失明的主要原因。在 DR 的发病机制中，慢性高血糖导致视网膜血管壁的生化和结构改变，导致高通透性和无灌注。由于血管内皮生长因子（VEGF）已被发现在 DR 的发病机制中起重要作用，因此本文综述了玻璃体内抗 VEGF 药物对 DR 患者视网膜无灌注的影响。基于现有文献，抗 VEGF 药物已被证明可改善 DR 严重程度，但不能逆转视网膜缺血。已发表研究的结果存在争议，并且因视网膜无灌注的部位以及评估视网膜无灌注的成像方式而异。在黄斑无灌注的情况下，大多数研究表明，接受玻璃体内抗 VEGF 药物治疗的 DR 患者的眼底荧光血管造影（FFA）和光学相干断层扫描血管造影（OCTA）均无变化，而少数研究报告称，随着中心凹无血管区（FAZ）的扩大，无灌注恶化。关于周边缺血，使用宽视野 FFA 的研究表明，抗 VEGF 治疗后无灌注区得到改善或稳定。然而，使用宽视野 OCTA 显示抗 VEGF 治疗后视网膜血管无再灌注迹象。仍需要进行具有长期随访和大样本量的前瞻性研究，以得出可靠的结论。
