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对糖尿病视网膜病变的认识及治疗的发展

Stitt AW, Curtis TM, Chen M, et al.

期刊名称:Prog Retin Eye Res

卷期:2016年3月第51卷

关键词:
视网膜 糖尿病

摘要

糖尿病视网膜病变是糖尿病最经常发生的并发症,并且在全球范围内仍然是导致视力损害的主要因素。其病因和病理已经进行了半个世纪的广泛研究,然而让人失望的是几乎没有治疗的方法。尽管一些新的治疗方法已经用于糖尿病黄斑水肿(DMO)的治疗(如,玻璃体腔内注射血管内皮细胞生长因子抑制剂,也就是anti-VEGFs,和新的类固醇激素),高达50%的患者治疗无效。再者,对于患有增殖型糖尿病视网膜病变(PDR)的患者,激光光凝仍然是主要的治疗方案,尽管激光光凝本身是一种破坏性的治疗过程。这一综述总结了糖尿病视网膜病变的临床特点及其危险因素。这一综述还描述了视网膜病变的细节和我们对于其病因理解的先进程度是如何帮助我们寻找新的治疗靶点。我们强调,尽管已经有了显著的进展,但是仍然存在对更好了解其基础机制的紧迫需求,以使我们能够发展出可靠、稳定的方法来鉴别有高危因素的患者,并在出现视力丢失之前进行有效的干预。

Diabetic retinopathy is the most frequently occurring complication of diabetes mellitus and remains a leading cause of vision loss globally. Its aetiology and pathology have been extensively studied for half a century, yet there are disappointingly few therapeutic options. Although some new treatments have been introduced for diabetic macular oedema (DMO) (e.g. intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') and new steroids), up to 50% of patients fail to respond. Furthermore, for people with proliferative diabetic retinopathy (PDR), laser photocoagulation remains a mainstay therapy, even though it is an inherently destructive procedure. This review summarises the clinical features of diabetic retinopathy and its risk factors. It describes details of retinal pathology and how advances in our understanding of pathogenesis have led to identification of new therapeutic targets. We emphasise that although there have been significant advances, there is still a pressing need for a better understanding basic mechanisms enable development of reliable and robust means to identify patients at highest risk, and to intervene effectively before vision loss occurs.


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