Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA.
Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, TX, USA.
Eye (Lond). 2022 Feb;36(2):249-256. doi: 10.1038/s41433-021-01649-0. Epub 2022 Jan 11.
Diabetic retinopathy is a major cause of vision loss worldwide and areas of retinal non-perfusion (RNP) are a key pathologic feature of the vascular component of diabetic retinopathy. While there is a need for a more complete understanding of the natural history of RNP development and progression, overall, increasing RNP has been closely linked with worsening DR severity. Both traditional and novel approaches to quantitative image assessment are being explored to advance our understanding of the vascular, physiologic and functional changes associated with progressive RNP. Retinal ischemia secondary to RNP leads to tissue hypoxia and changes in the expression of a host of signalling molecules. Current anti-vascular endothelial growth factor and steroid pharmaceutical agents appear to be unable to reperuse areas of RNP, but may be able to slow the progressive longitudinal accumulation of RNP with regular retreatments. There remains a tremendous unmet need for pharmacotherapies that can slow RNP progression and ultimately reperfuse areas of the non-perfused retina. Towards this end, novel targets including the semaphorin family are being investigated.
糖尿病性视网膜病变是全球范围内导致视力丧失的主要原因，视网膜无灌注区（RNP）是糖尿病性视网膜病变血管成分的关键病理特征。虽然需要更全面地了解 RNP 发展和进展的自然史，但总的来说，RNP 的增加与 DR 严重程度的恶化密切相关。目前正在探索传统和新型定量图像评估方法，以加深我们对与进行性 RNP 相关的血管、生理和功能变化的理解。RNP 引起的视网膜缺血导致组织缺氧和一系列信号分子表达的改变。目前的抗血管内皮生长因子和类固醇药物似乎无法使 RNP 再灌注，但可能能够通过定期撤退来减缓 RNP 的进行性纵向积累。对于能够减缓 RNP 进展并最终使无灌注视网膜区域再灌注的治疗方法，仍存在巨大的未满足需求。为此，正在研究新型靶点，包括信号素家族。
