治疗早期和晚期糖尿病视网膜病变的新见解。

New Insights into Treating Early and Advanced Stage Diabetic Retinopathy.

机构信息

Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Vall d'Hebron Campus, 08035 Barcelona, Spain.

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ICSIII), 28029 Madrid, Spain.

出版信息

Int J Mol Sci. 2022 Jul 31;23(15):8513. doi: 10.3390/ijms23158513.

Abstract

Diabetic retinopathy (DR) is the leading cause of preventable blindness in the working-age population. The disease progresses slowly, and we can roughly differentiate two stages: early-stage (ESDR), in which there are mild retinal lesions and visual acuity is generally preserved, and advanced-stage (ASDR), in which the structural lesions are significant and visual acuity is compromised. At present, there are no specific treatments for ESDR and the current recommended action is to optimize metabolic control and maintain close control of blood pressure. However, in the coming years, it is foreseeable that therapeutic strategies based in neuroprotection will be introduced in the clinical arena. This means that screening aimed at identifying patients in whom neuroprotective treatment might be beneficial will be crucial. Regarding the treatment of ASDR, the current primary course is based on laser photocoagulation and intravitreal injections of anti-angiogenic factors or corticosteroids. Repeated intravitreal injections of anti-VEGF agents as the first-line treatment would be replaced by more cost-effective and personalized treatments based on the results of "liquid biopsies" of aqueous humor. Finally, topical administration (i.e., eye drops) of neuroprotective, anti-inflammatory and anti-angiogenic agents will represent a revolution in the treatment of DR in the coming decade. In this article, all these approaches and others will be critically discussed from a holistic perspective.

摘要

糖尿病视网膜病变(DR)是导致工作年龄人群可预防失明的主要原因。该疾病进展缓慢,我们大致可以将其分为两个阶段:早期(ESDR),此时存在轻度视网膜病变,视力通常保持正常,和晚期(ASDR),此时结构病变显著,视力受损。目前,对于 ESDR 尚无特定的治疗方法,目前推荐的措施是优化代谢控制并密切控制血压。然而,可以预见,在未来几年,基于神经保护的治疗策略将引入临床领域。这意味着筛查旨在确定可能受益于神经保护治疗的患者将是至关重要的。关于 ASDR 的治疗,目前的主要治疗方案基于激光光凝和眼内注射抗血管生成因子或皮质类固醇。重复眼内注射抗 VEGF 药物作为一线治疗方法将被基于房水“液体活检”结果的更具成本效益和个性化的治疗方法所取代。最后,神经保护、抗炎和抗血管生成药物的局部给药(即滴眼剂)将代表 DR 在未来十年治疗的革命。在本文中,将从整体角度对所有这些方法和其他方法进行批判性讨论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f08d/9368971/eb74f0d317fe/ijms-23-08513-g001.jpg

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