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视网膜血管疾病中黄斑水肿的治疗:2021年更新

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update.

作者信息

Grzybowski Andrzej, Markeviciute Agne, Zemaitiene Reda

机构信息

Department of Ophthalmology, University of Warmia and Mazury, 10-561 Olsztyn, Poland.

Institute for Research in Ophthalmology, 60-836 Poznan, Poland.

出版信息

J Clin Med. 2021 Nov 15;10(22):5300. doi: 10.3390/jcm10225300.

Abstract

Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.

摘要

黄斑水肿(ME)与多种病症相关;然而,ME的主要病因是视网膜静脉阻塞(RVO)和糖尿病。激光光凝术曾是治疗ME的金标准,现已被抗血管内皮生长因子(抗VEGF)玻璃体腔内注射所取代。尽管这种治疗方法有效,但为了维持抗VEGF治疗的效果需要频繁注射,而且由于许多患者对该治疗反应不佳,ME通常是一种可导致永久性视力损害的慢性疾病。目前缺乏针对ME治疗的通用建议,这凸显了审查治疗方法的重要性,包括近期的抗VEGF药物、玻璃体腔内类固醇植入物和阈下微脉冲激光。我们回顾了相关研究,重点关注2019年至2021年间发表的文章,并使用了以下关键词:黄斑水肿、糖尿病性黄斑水肿、视网膜静脉阻塞、激光光凝术、抗VEGF和玻璃体腔内注射。我们的结果表明,在难治性病例中,不同治疗方法的联合使用可能有益。此外,人工智能(AI)在不久的将来可能有助于为患者选择最佳治疗方案。

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