Prevention and Treatment of Diabetic Retinopathy: Evidence from Clinical Trials and Perspectives
Prevention and Treatment of Diabetic Retinopathy: Evidence from Clinical Trials and Perspectives
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DOI：
10.2174/157339911795843168
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发表时间：
2011-01-01
影响因子：
3.3
通讯作者：
Ruggenenti, Piero
中科院分区：
文献类型：
--
作者：
Abbate, Manuela;Cravedi, Paolo;Ruggenenti, Piero
糖尿病视网膜病变是糖尿病最常见的微血管并发症，也是导致西方国家工作年龄成年人失明的主要原因。大型观察性和随机研究一致表明，最佳血糖和血压控制是干预策略的关键组成部分，旨在阻止或逆转疾病，并限制进展到增殖性阶段的风险，在大多数严重病例中，增殖性阶段导致视力丧失直至失明。他汀类药物对血脂异常的改善，特别是与非诺贝特联合使用，也可能改善视网膜病变，这与高脂血症的潜在致病作用一致。最近，也有证据表明肾素-血管紧张素系统（RAS）抑制剂可能选择性地预防或延缓视网膜病变的进展，这可能是因为RAS局部激活对视网膜结构和功能变化具有特异性保护作用。因此，通过RAS抑制来控制代谢和血压是为了防止或限制视网膜病变的发生及其向视力威胁阶段的进展。抗血管内皮生长因子（VEGF）药物的局部治疗正在成为晚期视网膜病变的一种治疗选择，以限制激光光凝治疗的需要。然而，由于系统性不良事件的风险，应谨慎考虑此选择。
Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and is the leading cause of blindness amongst working-age adults in Western countries. Large observational and randomized studies have consistently shown that optimal blood glucose and blood pressure control is the key component of intervention strategies aimed to halt or regress the disease, and limit the risk of progression to the proliferative stage, with consequent visual loss up to blindness in most severe cases. Amelioration of dyslipidemia by statins, especially if combined with fenofibrate, may also ameliorate retinopathy in line with a potential pathogenic role of hyperlipidemia. Recently, evidence has also emerged that renin-angiotensin system (RAS) inhibitors may electively prevent or delay progression of retinopathy, possibly because of specific protective effect against the structural and functional retinal changes sustained by local RAS activation. Thus, metabolic and blood pressure control by RAS inhibition is to prevent or limit the onset of retinopathy and its progression towards visual-threatening stages.Topic treatment with anti-vascular endothelial growth factor (VEGF) agents is emerging as a treatment option for retinopathy in advanced stages to limit the need for laser photocoagulation. This option however should be considered with caution due to the risk of systemic adverse events.