Novel approaches for treating diabetic retinopathy based on recent pathogenic evidence
Novel approaches for treating diabetic retinopathy based on recent pathogenic evidence
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DOI：
10.1016/j.preteyeres.2015.04.003
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发表时间：
2015-09-01
影响因子：
17.8
通讯作者：
Hernandez, Cristina
中科院分区：
文献类型：
--
作者：
Simo, Rafael;Hernandez, Cristina
在发达国家，糖尿病视网膜病变仍然是导致失明的主要原因。目前的治疗目标是DR的晚期，此时视力已经受到严重影响。更好地了解DR的发病机制将允许针对DR的早期阶段制定更有效的预防/干预策略。本文对该问题的最新进展进行了批判性回顾，并讨论了尚未克服的问题。神经保护作为一种治疗早期DR的新方法已被特别强调。DR的发展和进展是不均匀的，除了血糖水平和血压外，它还取决于遗传因素，这些因素仍有待阐明。此外，致病途径在所有患者中的作用也不尽相同。在不久的将来，当DR的个体化治疗变得可行时，所有这些因素都应该被考虑在内。视网膜成像采集、有用循环生物标志物的识别和生物样本的个性化分析等新技术可以促进dr的早期和个性化治疗的发展。最后，需要注意的是，只有眼科医生、糖尿病医生、基础研究人员、药物经济学专家和卫生保健提供者致力于设计针对DR预防和早期阶段的合理策略，将有效减轻负担并改善这一破坏性糖尿病并发症的临床结果。(C) 2015 Elsevier Ltd.版权所有。
Diabetic retinopathy remains as a leading cause of blindness in developed countries. Current treatments target late stages of DR when vision has already been significantly affected. A better understanding of the pathogenesis of DR would permit the development of more efficient preventional/interventional strategies against early stages of DR. In this article a critical review of the state of the art of this issue is provided along with a discussion of problems which have yet to be overcome. Neuroprotection as a new approach for the treatment of the early stages of DR has been particularly emphasized.The development and progression of DR is not homogeneous and, apart from blood glucose levels and blood pressure, it depends on genetic factors which remain to be elucidated. In addition, the role of the pathogenic pathways is not the same in all patients. All these factors should be taken into account in the near future when an individualized oriented treatment for DR could become feasible. The new techniques in retinal imaging acquisition, the identification of useful circulating biomarkers and the individualized analysis of biological samples could facilitate the development of early and personalized therapy in the setting of DR.Finally, it should be noted that only a coordinated action among ophthalmologists, diabetologists, basic researchers, experts in pharmaco-economics and health care providers addressed to the design of rational strategies targeting prevention and the early stages of DR will be effective in reducing the burden and improving the clinical outcome of this devastating complication of diabetes. (C) 2015 Elsevier Ltd. All rights reserved.