Iyer Siva S R, Radhakrishnan Nila S, Roohipourmoallai Ramak, Guerin Cynthia M, Maylath Jeremy S, Garson Nickolas
Vitreoretinal Associates, Gainesville, FL, United States of America.
University of Florida College of Medicine, Department of Medicine, United States of America.
Am Heart J Plus. 2023 Feb 9;29:100270. doi: 10.1016/j.ahjo.2023.100270. eCollection 2023 May.
Diabetic retinopathy (DR) is a potentially blinding disease originating from small vessel damage in the retina in chronic hyperglycemic states. DR has a complex multi-pathway driven pathogenesis resulting in diabetic macular edema and retinal ischemia, the former being the most common cause of vision impairment in DR. Hypoxia induced cytokines stimulate vascular endothelial growth factor (VEGF) production and subsequent angiogenesis with resultant mechanical retinal damage over time. Anti-VEGF therapy is effective for the treatment of center-involving diabetic macular edema. There is evolving evidence showing the effectiveness of anti-VEGF as both adjuvant and monotherapy in the treatment of proliferative DR, however laser photocoagulation continues to remain the standard of care. DR in large cohort studies has been shown to be an independent risk factor for the development of cardiovascular disease and mortality. In addition, changes in retinal vascular caliber ratios may have implications for risk of macrovascular events with a gender discrepancy towards women.
糖尿病性视网膜病变（DR）是一种潜在的致盲性疾病，源于慢性高血糖状态下视网膜的小血管损伤。DR具有复杂的多途径驱动发病机制，导致糖尿病性黄斑水肿和视网膜缺血，前者是DR中视力损害的最常见原因。缺氧诱导的细胞因子刺激血管内皮生长因子（VEGF）的产生以及随后的血管生成，随着时间的推移导致机械性视网膜损伤。抗VEGF治疗对治疗累及中心的糖尿病性黄斑水肿有效。越来越多的证据表明，抗VEGF作为辅助治疗和单一疗法在增殖性DR治疗中均有效，然而激光光凝仍然是标准的治疗方法。大型队列研究表明，DR是心血管疾病发生和死亡的独立危险因素。此外，视网膜血管管径比值的变化可能对大血管事件的风险有影响，女性存在性别差异。
