Changing paradigms in the treatment of diabetic retinopathy
Changing paradigms in the treatment of diabetic retinopathy
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DOI：
10.1097/icu.0b013e328330b533
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发表时间：
2009-11-01
影响因子：
3.7
通讯作者：
Ola, Mohammad Shamsul
中科院分区：
文献类型：
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作者：
Abu El-Asrar, Ahmed M.;Al-Mezaine, Hani S.;Ola, Mohammad Shamsul
综述目的回顾当前糖尿病视网膜病变的治疗方法。最新发现糖尿病视网膜病变仍然是全世界失明的主要原因之一。严格的代谢控制、严格的血压控制、激光光凝和玻璃体切除术仍然是糖尿病视网膜病变的标准治疗方法。对于患有糖尿病性黄斑水肿的眼睛，局部/网格光凝是比玻璃体内注射曲安奈德更好的治疗方法。目前的证据表明，玻璃体内注射曲安奈德或抗血管内皮生长因子药物是激光光凝或玻璃体切除术的有效辅助治疗。然而，曲安西龙与眼内压升高和白内障的风险相关。玻璃体切除术去除后玻璃体而不剥离内界膜似乎对患有持续性弥漫性糖尿病黄斑水肿的眼睛有效，特别是对于伴有玻璃体黄斑牵拉的眼睛。新兴疗法包括胰岛细胞移植、非诺贝特、ruboxistaurin 和玻璃体内透明质酸酶。总结各种有前景的新医学和外科疗法正在出现，但需要更多随机对照临床试验来阐明它们单独或联合使用的作用。
Purpose of reviewTo review current treatment approaches in diabetic retinopathy.Recent findingsDiabetic retinopathy remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema. The current evidence suggests that intravitreal triamcinolone acetonide or antivascular endothelial growth factor agents are effective adjunctive treatment to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, and intravitreal hyaluronidase.SummaryA variety of promising new medical and surgical therapies are emerging, but more randomized controlled clinical trials are required to clarify their role alone or in combination.