糖尿病黄斑水肿患者行醋酸氟轻松治疗规范：2023年专家共识解读

为了更好地了解视网膜病专家对于炎症在糖尿病视网膜病变(DR)和糖尿病黄斑水肿(DME)中所起作用的一致程度,以及使用0.19 mg醋酸氟轻松(FAc)玻璃体内注射治疗DME的效果认同情况,起草了一份共识调查报告,共有56名美国视网膜病专家完成了整个共识调查。医生高度同意炎症在DR/DME的病理生理学、注射负荷和患者依从性、FAc玻璃体内注射的有效性和安全性方面的作用。然而,对于FAc植入剂对DR进展的影响、FAc作为DME的基线治疗以及类固醇刺激降低FAc使用后眼压风险的有效性,尚未达成共识。本文就该专家共识进行解读,为FAc玻璃体内注射治疗DR/DME方案的进一步研究和应用提供参考。     

糖尿病性黄斑水肿

糖尿病性黄斑水肿是糖生视网膜病变的组成部分，同时也是视力损害或丧失的最常见原因，年十年来，国外对此进行了广泛研究并取得了一定的进展。本回顾有关献，对糖尿病性黄斑水肿的定义，病因学，分类，临床特征，光凝治疗技术与方法及其并发症作了综述。     

糖尿病黄斑水肿的处理

糖尿病视网膜病变是工作年龄人群致盲重要原因,而糖尿病黄斑水肿是引起糖尿病患者视力下降的主要原因,早期发现,适当治疗能有效减少因糖尿病性黄斑水肿引起的视力丧失。目前光凝是治疗糖尿病黄斑水肿最有效的方法。对有些病人,玻璃体切割术被证明是有效的。     

糖尿病性黄斑水肿的激光治疗

目的观察激光治疗糖尿病性黄斑水肿（DME）的疗效。设计回顾性临床研究。研究对象DME患者97例（133眼），其中局限水肿92眼，弥漫性水肿41眼。方法局限水肿行微血管瘤或扩张的毛细血管直接光凝。弥漫水肿行C形格栅或环形格栅光凝。主要指标视力和眼底荧光素血管造影。结果局限水肿中视力提高19眼（20．7％），视力不变63眼（68．5％），视力下降10眼（10．9％）。弥漫水肿中视力提高3眼（7．3％），视力不变27眼（65．9％），视力下降11眼（26.8％）（两组视力变化，χ^2=3．653，P=0．056）。局限水肿中水肿消退24眼（26．1％），水肿减轻48眼（52．2％），水肿未退20眼（21．7％）。弥漫水肿中水肿消退5眼（12．2％），水肿减轻18眼（43．9％），水肿未退18眼（43．9％）（两组水肿消退，）[χ^2=6．826，P=0．009）。结论激光治疗DME有效，局限性黄斑水肿比弥漫性黄斑水肿效果好。     

糖尿病黄斑水肿相关因素分析

目的:探讨糖尿病黄斑水肿(diabetic macular edema,DME)与糖尿病病程和视力之间的关系。方法: 回顾性分析40例40眼荧光素眼底血管造影(fluorescence fundus angiography,FFA)及光学相干断层扫描(optical coherence tomography,OCT)确诊的DME患者的检查结果、糖尿病病程和视力等临床资料。分析各种类型DME与以上相关因素的关系。结果: DME患者40例40眼中,局限型DME14眼(35%),弥漫型20眼(50%),囊样水肿6眼(15%)。患者的视力与DME的类型具有显著相关性(r=-0.835,P=0.000),黄斑囊样水肿较局限型水肿对视力的损害更严重。糖尿病病程与DME的类型具有显著相关性(r=0.472,P=0.002)。结论: DME与糖尿病病程、视力均存在显著相关性。     

阿柏西普玻璃体内注射治疗糖尿病性黄斑水肿中国专家共识(2021)

糖尿病性黄斑水肿(DME)是糖尿病视网膜病变(DR)常见的严重并发症之一。2017年中国糖尿病患者人数已居全球首位,约有33.62%的DR患者同时患有DME,及时有效地治疗DME对改善患者的视觉质量和生活质量具有重要意义。近年来抗血管内皮生长因子(VEGF)药物和糖皮质激素的玻璃体内注射为DME的治疗开辟了新的途径。V...     

玻璃体腔注射雷珠单抗治疗糖尿病黄斑水肿与视网膜静脉阻塞性黄斑水肿的疗效对比

目的观察对比玻璃体腔注射雷珠单抗治疗糖尿病黄斑水肿（DME）与视网膜静脉阻塞性黄斑水肿（RVO-ME）的疗效。方法2013年5月至2014年12月在安徽医科大学第一附属医院眼科门诊确诊为DME 及RVO-ME的患者,共26例（33只眼）,其中DME 17只眼,RVO-ME 16只眼。患眼接受玻璃体腔注射雷珠单抗（0．5 mg／0．05 ml）治疗,治疗前和治疗后1 d、2周、4周定期门诊回访观察最佳矫正视力（BCVA）及中央黄斑厚度（CST）。比较雷珠单抗治疗两组治疗前和治疗后的BCVA及CST改变情况。结果 DME组与RVO-ME组治疗后1 d、2周、4周的BCVA均较治疗前明显提高,差异均有统计学意义（P ＜0．05）。DME组与RVO-ME组治疗后4周的CST均较治疗前明显改善,差异均有统计学意义（P ＜0．05）。DME组与RVO-ME组之间在BCVA及CST方面比较,差异均无统计学意义（P ＞0．05）。结论玻璃体腔注射雷珠单抗治疗DME及RVO-ME均可减轻黄斑水肿和改善视力,两者治疗效果无明显差异。     

糖尿病性黄斑水肿的激光治疗

黄斑水肿是糖尿病性视网膜病变引起视力下降的重要原因，近二十年的研究表明激光光凝可减轻黄斑水肿使病人视力保留或提高，本就其治疗机理，技术方法，治疗时机，治疗效果及其并发症加以综述。     

糖尿病性黄斑水肿的激光治疗

糖尿病性黄斑水肿(diabetic macular edema，DME)是引起糖尿病患者视力恶化的主要原因。自激光应用于眼科以来，根据资料和研究表明激光治疗黄斑水肿可以稳定和提高患者的视力。本文就DME的病因分型、激光治疗的原理、治疗方法、治疗效果、相关问题和合理应用进行综述。     

糖尿病性黄斑水肿与炎症

糖尿病性黄斑水肿可引起视网膜细胞受损和视网膜纤维化,是导致患者视力下降的首要原因.其发生和发展与糖基化终末产物、白细胞瘀滞和血管内皮生长因子及其他炎性因子的相互作用有关.采用非甾体类抗炎药、生物降解缓释系统、淋巴细胞功能相关性抗原-1拮抗剂等靶向治疗黄斑水肿已在临床试验中取得一定疗效,为糖尿病性黄斑水肿治疗提供新的方法和思路.     

Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group’s efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts’ panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it.RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients’ treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created.CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.     

Diabetic macular edema treatment guidelines in India: All India Ophthalmological Society Diabetic Retinopathy Task Force and Vitreoretinal Society of India consensus statement

Diabetic macular edema (DME) is a common cause of moderate visual impairment among people with diabetes. Due to the rising number of people with diabetes in India, the absolute numbers of people with DME are significant. There are several treatment options for DME, and the choice of treatment is based on the availability of retinal specialists and infrastructure for the delivery of treatment. A major challenge is the out-of-pocket expenditure incurred by patients as most treatment options are costly. Treatment also varies based on the associated ocular and systemic conditions. The All India Ophthalmology Society (AIOS) and the Vitreo-Retinal Society of India (VRSI) have developed this consensus statement of the AIOS DR task force and VRSI on practice points of DME management in India. The objective is to describe the preferred practice patterns for the management of DME considering the different presentations of DME in different clinical scenarios.     

糖尿病性黄斑水肿患者行玻璃体内皮质类固醇植入后眼压的监测和管理——2022年欧洲专家共识解读

向玻璃体内植入皮质类固醇药物是治疗糖尿病性黄斑水肿的有效方法,但存在引起患者高眼压的副作用。为规范皮质类固醇植入物的临床使用,一些来自欧洲各地的眼科专家近期发布了关于“糖尿病性黄斑水肿患者行玻璃体内皮质类固醇植入后眼压的监测和管理”的共识,本文对该共识进行全面解读。     

中心凹型糖尿病性黄斑水肿研究进展

糖尿病性黄斑水肿(DME)的特征是渗出液在黄斑积聚,是糖尿病患者最常见的威胁视力的视网膜疾病.其中,中心凹型DME是糖尿病患者视力丧失的主要原因,但对中心凹型DME的认识,尤其是病理生理机制及治疗方案的选择仍有进一步探讨的必要.目前,国内有关中心凹型DME的相关报道较少,对该病有一个完整的认识可以提高临床工作者对此病的...     

缓释激素植入物治疗黄斑水肿的研究进展

黄斑水肿是多种眼底疾病视力下降的主要原因。玻璃体内药物，例如抗血管内皮生长因子或皮质类固醇，近年来变得越来越流行并且广泛用于治疗黄斑水肿。现在似乎更常提到持续释放药物以延长玻璃体内活动的时间，并且皮质类固醇在抑制黄斑水肿的炎症过程中起关键作用。玻璃体内缓释激素植入物形式的强效皮质类固醇已被批准用于各种眼部病因。本综述评估了缓释激素植入物在黄斑水肿治疗中的作用，主要集中在地塞米松玻璃体内植入物。     

Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians.     

Topical interferon therapy in uveitic macular edema

Purpose:To evaluate efficacy of topical interferon alfa-2b (IFN) in the treatment of uveitic macular edema (UME).Methods:This is a prospective, interventional case study of patients with UME. Injection IFN was reconstituted into eye drops and a four times/day (QID) application was prescribed. Central macular thickness (CMT) on optical coherence tomography (OCT) scan was evaluated. Improvement in CMT by ≥50 mm from the baseline was studied in eyes with presenting CMT ≥400 µm.Results:Twenty eyes of 20 patients with UME were studied: anterior uveitis (n = 3), anterior + intermediate uveitis (n = 5), posterior uveitis (n = 3), retinal vasculitis (n = 3), and panuveitis (n = 6). Mean CMT at the presentation was 423.3 µm (range: 270–604 µm), which improved at 1 month (n = 16), 2 months (n = 10), and ≥3 months (n = 11) follow-up, to 415.3 µm (range: 247–579 mm) (P = 0.411), 364.4 mm (range: 258–566 µm) (P = 0.099), 344 µm (range: 258–484 µm) (P = 0.001), respectively. Twelve eyes of 12 patients had presenting CMT ≥400 µm. In these cases, decrease in CMT by ≥50 µm was seen in 4/10, 4/5, and 5/6 eyes at 1 and 2 months and ≥3 months follow-up. Mean follow-up was 4 months (range: 1–17 months). Complete resolution of UME was seen only in three eyes. No ocular or systemic side effects were observed.Conclusion:Topical IFN therapy in QID doses is safe but may have limited role in UME. Long-term therapy may improve its efficacy. Larger studies with dose modification, combination with other drugs, and with homogeneous uveitis population are recommended.     

氪黄激光治疗糖尿病性黄斑水肿

目的：探讨氪黄激光治疗糖尿病性黄斑水肿的疗效。方法：对４０例（７４只眼）非增殖期及增殖早期糖尿病性视网膜病变黄斑水肿患者,对照眼荧光血管造影,采用氪黄激光进行直接或格栅光凝。随访３－１７个月,每３个月复查视力及眼底荧光血管造影。分析视力及黄斑水肿变化情况,结果：光凝治疗后视力进行１７只眼,占２３％,无变化４５只眼,占６１％,减退１２只眼,占１６％,黄斑水肿消失８只眼,占１１％,明显减轻２１只眼,占     

玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿的影响

目的　探讨玻璃体内注射康柏西普对弥漫性糖尿病性黄斑水肿（diabetic macular edema,DME）的影响。方法　选取2016年7月至2017年7月牡丹江医学院红旗医院眼科收治的弥漫性DME患者51例51眼,将患者分为3组,每组各17例17眼:单纯玻璃体内注射康柏西普0.5 mg组（A组）;玻璃体内注射康柏西普0.5 mg联合改良黄斑格栅样光凝组（B组）;单纯改良黄斑格栅样光凝组（C组）。分别于治疗前及治疗后1周、1 个月、3个月和6个月对患者进行光学相干断层扫描检测黄斑中心凹厚度（central macular thickness,CMT）、眼底荧光血管造影（fundus fluorescein angiography,FFA）、最佳矫正视力（best corrected visual acuity,BCVA）、裂隙灯、眼压等检查,比较三种治疗方式的疗效和安全性。结果　三种治疗方式均能改善弥漫性DME患者BCVA、CMT、视网膜新生血管渗漏,但A组、B组疗效均优于C组（均为P＜0.05）。A组、B组患者BCVA改善情况差异无统计学意义（P＞0.05）,但B组患者CMT（197.47±45.26）μm及视网膜新生血管渗漏（9.91±3.18）mm²改善情况优于A 组（205.59±47.33）μm、（13.24±4.87）mm²（P＜0.001）,且无光凝术及康柏西普相关的并发症发生。结论　改良黄斑格栅样光凝术联合玻璃体内注射康柏西普能迅速减轻弥漫性DME及新生血管形成,从而提高患者视力,其疗效优于单纯改良黄斑格栅样光凝术和单纯康柏西普玻璃体内注射。