New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA; Department of Ophthalmology, Tanta University, Tanta, Egypt.
New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
Surv Ophthalmol. 2023 Mar-Apr;68(2):147-174. doi: 10.1016/j.survophthal.2022.11.008. Epub 2022 Nov 24.
Intravitreal antivascular endothelial growth factor (anti-VEGF) treatment has drastically improved the visual and anatomical outcomes in patients with diabetic macular edema (DME); however, success is not always guaranteed, and a proportion of these eyes demonstrate persistent DME (pDME) despite intensive treatment. While standardized criteria to define these treatment-resistant eyes have not yet been established, many studies refer to eyes with no clinical response or an unsatisfactory partial response as having pDME. A patient is considered to have pDME if the retinal thickness improves less than 10-25% after 6 months of treatment. A range of treatment options have been recommended for eyes with pDME, including switching anti-VEGF agents, using corticosteroids and/or antioxidant drugs in adjunct with anti-VEGF therapy, and vitrectomy. In addition, multimodal imaging of DME eyes may be advantageous in predicting the responsiveness to treatment; this is beneficial when initiating alternative therapies. We explore the literature on persistent DME regarding its defining criteria, incidence, the baseline biological markers that may be useful in anticipating the response to treatment, and the available treatment options.
玻璃体内抗血管内皮生长因子 (anti-VEGF) 治疗极大地改善了糖尿病性黄斑水肿 (DME) 患者的视力和解剖学结果；然而，并非总是能成功，尽管进行了强化治疗，这些眼中仍有一部分表现为持续性 DME (pDME)。虽然尚未建立定义这些治疗抵抗性眼的标准化标准，但许多研究将无临床反应或不满意的部分反应的眼称为 pDME。如果视网膜厚度在治疗 6 个月后改善小于 10-25%，则认为患者患有 pDME。对于 pDME 眼，已经推荐了一系列治疗选择，包括更换抗 VEGF 药物、在抗 VEGF 治疗的基础上联合使用皮质类固醇和/或抗氧化药物，以及玻璃体切除术。此外，DME 眼的多模态成像可能有利于预测对治疗的反应性；在开始替代治疗时，这是有益的。我们探讨了关于持续性 DME 的文献，包括其定义标准、发生率、可能有助于预测治疗反应的基线生物学标志物，以及可用的治疗选择。
