Department of Ophthalmology, JSS Hospital, JSS AHER, Mysuru, Karnataka, India.
Indian J Ophthalmol. 2021 Nov;69(11):3321-3327. doi: 10.4103/ijo.IJO_837_21.
Hallmark of Diabetic Retinopathy (DR) is blood-retinal barrier alteration. Vascular endothelial growth factor (VEGF) and inflammation are involved in the pathogenesis of DR. Anti-VEGFs and lasers are effective in treating DR but have numerous drawbacks, hence the need to develop alternative therapies that may delay the onset or progression of DR.
Fifteen patients were recruited in each group; the study group was on immunosuppressants for some other coexisting disease and the control group was not on them. Each subject underwent detailed history, ophthalmic examination, and glycosylated hemoglobin (HbA1c) and renal function tests at the time of recruitment and the end of one year. Primary outcome measure was to compare the progression of DR in diabetics on immunosuppressant versus those not on it.
Median age in the study and control group was 57 years and 60 years, respectively (P = 0.6). Median duration of diabetes was 11 and 12 years in the study and control group, respectively (P = 0.7). HbA1c for the study and control group for first visit was 7.6% and 8.0%, respectively (P = 0.26) and for second visit was 7.5% and 8.1%, respectively (P = 0.11). Hypertensives in the study and control groups were 9 and 4, respectively (P = 0.065); renal disease in the study and control groups was 4 and 2, respectively (P = 0.361). The control group showed 33.3% progression of DR, and no progression was seen in the study group (P = 0.014).
Immunosuppressants seemed to delay the onset and progression of DR in the earlier stages.
糖尿病视网膜病变（DR）的特征是血视网膜屏障改变。血管内皮生长因子（VEGF）和炎症参与了 DR 的发病机制。抗 VEGF 和激光治疗对 DR 有效，但存在许多缺点，因此需要开发替代疗法，以延缓 DR 的发生或进展。
每组招募 15 名患者；研究组因其他共存疾病而使用免疫抑制剂，对照组则未使用。每位受试者在招募时和一年后均接受详细的病史、眼科检查以及糖化血红蛋白（HbA1c）和肾功能检查。主要观察指标是比较使用免疫抑制剂的糖尿病患者与未使用免疫抑制剂的患者 DR 的进展情况。
研究组和对照组的中位年龄分别为 57 岁和 60 岁（P = 0.6）。研究组和对照组糖尿病的中位病程分别为 11 年和 12 年（P = 0.7）。研究组和对照组第一次就诊时的 HbA1c 分别为 7.6%和 8.0%（P = 0.26），第二次就诊时的 HbA1c 分别为 7.5%和 8.1%（P = 0.11）。研究组和对照组的高血压患者分别为 9 例和 4 例（P = 0.065）；研究组和对照组的肾脏疾病患者分别为 4 例和 2 例（P = 0.361）。对照组 DR 进展率为 33.3%，而研究组未见进展（P = 0.014）。
免疫抑制剂似乎在早期阶段延缓了 DR 的发生和进展。
