Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida 910-1193, Japan.
Medicina (Kaunas). 2023 Feb 22;59(3):435. doi: 10.3390/medicina59030435.
This study aims to elucidate the role of microaneurysms (MAs) in the pathogenesis and treatment of diabetic retinopathy (DR) and diabetic macular edema (DME), the major causes of acquired visual impairment. We synthesized the relevance of findings on the clinical characteristics, pathogenesis, and etiology of MAs in DR and DME and their role in anti-vascular endothelial growth factor (VEGF) therapy. MAs, a characteristic feature in DR and DME, can be detected by fluorescein angiography, optical coherence tomography (OCT) and OCT angiography. These instrumental analyses demonstrated a geographic and functional association between MA and ischemic areas. MA turnover, the production and loss of MA, reflects the activity of DME and DR. Several cytokines are involved in the pathogenesis of MAs, which is characterized by pericyte loss and endothelial cell proliferation in a VEGF-dependent or -independent manner. Ischemia and MAs localized in the deep retinal layers are characteristic of refractory DME cases. Even in the current anti-VEGF era, laser photocoagulation targeting MAs in the focal residual edema is still an effective therapeutic tool, but it is necessary to be creative in accurately identifying the location of MAs and performing highly precise and minimally invasive coagulation. MAs play a distinctive and important role in the pathogenesis of the onset, progression of DR and DME, and response to anti-VEGF treatment. Further research on MA is significant not only for understanding the pathogenesis of DME but also for improving the effectiveness of treatment.
本研究旨在阐明微动脉瘤（MAs）在糖尿病性视网膜病变（DR）和糖尿病性黄斑水肿（DME）发病机制和治疗中的作用，DR 和 DME 是获得性视力损害的主要原因。我们综合了有关 DR 和 DME 中 MAs 的临床特征、发病机制和病因及其在抗血管内皮生长因子（VEGF）治疗中的作用的研究结果的相关性。MAs 是 DR 和 DME 的特征性表现，可以通过荧光素血管造影、光学相干断层扫描（OCT）和 OCT 血管造影来检测。这些仪器分析显示 MA 与缺血区域之间存在地理和功能相关性。MA 周转，即 MA 的产生和损失，反映了 DME 和 DR 的活性。几种细胞因子参与了 MAs 的发病机制，其特征是周细胞丧失和内皮细胞增殖，这是 VEGF 依赖性或非依赖性的。缺血和位于深层视网膜的 MA 是难治性 DME 病例的特征。即使在当前的抗 VEGF 时代，针对局灶性残留水肿中的 MA 进行激光光凝仍然是一种有效的治疗工具，但有必要创造性地准确识别 MA 的位置，并进行高度精确和微创的凝固。MA 在 DR 和 DME 的发病机制、进展以及对抗 VEGF 治疗的反应中起着独特而重要的作用。对 MA 的进一步研究不仅对了解 DME 的发病机制具有重要意义，而且对提高治疗效果也具有重要意义。
