DIABETIC MACULAR EDEMA: A REVIEW
DIABETIC MACULAR EDEMA: A REVIEW
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DOI：
10.1016/s0161-6420(86)33650-9
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发表时间：
1986-07
期刊：
影响因子：
13.7
通讯作者：
G. Bresnick
中科院分区：
文献类型：
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作者：
G. Bresnick
糖尿病性黄斑水肿可分为局灶性和弥漫性两类，前者的特征是来自微动脉瘤的局灶性渗漏，通常伴有局灶性渗漏周围环状模式的血管外脂蛋白积聚，后者则是来自视网膜血管的弥漫性渗漏，通常伴有囊样黄斑改变。激光光凝针对微动脉瘤进行局灶性渗漏，并以网格模式应用于弥漫性渗漏。几项前瞻性随机临床试验表明，激光治疗的眼睛比未治疗的眼睛更好：激光光凝治疗的眼睛中适度视力改善的比率更高，视力恶化的比率更低。在糖尿病性黄斑水肿患者中，尤其是弥漫性变化，全身因素也可能起致病作用。由于心血管和肾脏疾病引起的液体潴留和高血压加剧了视网膜毛细血管渗漏。纠正全身异常（降低血压、利尿）可减少黄斑水肿，应作为糖尿病黄斑水肿患者总体管理的一部分。
Diabetic macular edema can be classified into a focal variety, characterized by focal leakage from microaneurysms, often with accumulation of extravascular lipoprotein in a circinate pattern around the focal leakage, and a diffuse variety, with diffuse leakage from retinal vessels often accompanied by cystoid macular changes. Laser photocoagulation is directed at microaneurysms for focal leakage and is applied in a grid pattern for diffuse leakage. Several prospective randomized clinical trials have shown that laser-treated eyes fare better than untreated eyes: there is a higher rate of modest visual improvement and a lower rate of visual deterioration in eyes treated with laser photocoagulation. In patients with diabetic macular edema, especially the diffuse variety, systemic factors also may play a pathogenic role. Fluid retention and hypertension due to cardiovascular and renal disease exacerbate retinal capillary leakage. Correction of systemic abnormalities (reduced blood pressure, diuresis) may reduce macular edema and should be included as part of the total management of patients with diabetic macular edema.