地塞米松缓释剂治疗糖尿病性黄斑水肿的研究进展

糖尿病性黄斑水肿(DME)是糖尿病患者视力丧失甚至失明的重要原因,其治疗方案多种多样,主要包括抗血管内皮生长因子、曲安奈德及激光光凝等,均具有较好的疗效,但也存在各自的局限性。近年来,地塞米松缓释剂作为一种新的治疗方案给其他治疗反应欠佳的DME患者带来了希望,同时具有疗效佳、持续时间长、安全性可接受及患者耐受性良好等优点,使其成为了目前的研究热点。本文就地塞米松缓释剂的药理特性、治疗DME的临床研究及适用条件进行阐述。     

抗VEGF治疗对不同类型DME患者黄斑中心凹无血管区的影响

目的 基于糖尿病性黄斑水肿(DME)的不同影像类型,采用OCTA探讨DME患者抗血管内皮生长因子(VEGF)治疗前后黄斑中心凹无血管区(FAZ)结构的变化。方法 回顾性分析2019年10月至2021年10月来我院就诊的经3+PRN抗VEGF治疗的51例62眼DME患者资料。根据黄斑水肿类型分为弥漫增厚型DME(DRT-DME)组30例(36眼)和黄斑囊样水肿型DME(CME-DME)组21例(26眼)。分别收集两组患者抗VEGF治疗前、治疗后3个月及治疗后6个月的临床资料和OCTA指标,包括最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)、FAZ面积、黄斑中心凹旁300μm范围内的视网膜血流密度(FD)和FAZ非圆度指数(AI),并对其进行比较分析。对CME-DME组患者抗VEGF治疗前后OCTA指标差值(治疗前与治疗后6个月差值)之间的相关性采用Spearman相关性分析。结果 与治疗前相比,DRT-DME组患者治疗后3个月和治疗后6个月各方位的CRT均下降、BCVA均改善(均为P<0.05),但FAZ面积、FD和AI的差异均无统计学意义(均为P>0.05)。与治...     

糖尿病性黄斑水肿的药物治疗及进展

糖尿病性黄斑水肿(diabetic macular edema, DME)是糖尿病患者眼部常见的并发症之一,也是导致糖尿病患者视力损伤的主要原因。血管内皮生长因子(vascular endothelial growth factor,VEGF)是目前DME治疗的重要靶点。目前对DME的主要治疗药物包括抗血管内皮生长因子和糖皮质激素(corticosteroid); 尚在发展中的新兴治疗药物有抗VEGF DARPin设计的锚蛋白重复序列(designed ankyrin repeat proteins,DARPins)、血管黏附蛋白(vascular adhesion protein)和整合素拮抗剂(integrin antagonist)等。本文就糖尿病性黄斑水肿的药物治疗及进展作一综述。     

糖尿病黄斑水肿对抗VEGF药物治疗的不同反应与糖尿病视网膜病变程度的相关性

目的：通过观察糖尿病黄斑水肿(diabetic macular edema,DME)患者对于玻璃体腔注射抗VEGF治疗的不同反应和糖尿病视网膜病变(diabetic retinopathy,DR)的不同程度之间的相关性,进一步阐释糖尿病黄伴水肿的发病机制和治疗策略。

方法：选择非增生性糖尿病视网膜病变(non proliferative diabetic retinopathy,NPDR)伴发DME的患者27例33眼,增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)伴发DME的患者32例34眼。均给予玻璃体腔注射抗VEGF药雷珠单抗,观察两组患者对该药的不同反应,并进行统计学比较。

结果：分别把患者治疗3、6mo时的最佳矫正视力(best corrected visual acuity,BCVA)和黄斑中心视网膜厚度(central macular thickness,CMT)和治疗前的BCVA、CMT作比较,NPDR组有统计学差异(P<0.05),PDR组无统计学差异(P>0.05)。NPDR组和PDR组比较,3、6mo时的BCVR和CMT均有统计学差异(P<0.05)。

结论：糖尿病视网膜病变的不同程度影响着糖尿病黄斑水肿对抗VEGF治疗的反应。     

Persistent diabetic macular edema: Definition,incidence, biomarkers,and treatment methods

Intravitreal antivascular endothelial growth factor (anti-VEGF) treatment has drastically improved the visual and anatomical outcomes in patients with diabetic macular edema (DME); however, success is not always guaranteed, and a proportion of these eyes demonstrate persistent DME (pDME) despite intensive treatment. While standardized criteria to define these treatment-resistant eyes have not yet been established, many studies refer to eyes with no clinical response or an unsatisfactory partial response as having pDME. A patient is considered to have pDME if the retinal thickness improves less than 10–25% after 6 months of treatment. A range of treatment options have been recommended for eyes with pDME, including switching anti-VEGF agents, using corticosteroids and/or antioxidant drugs in adjunct with anti-VEGF therapy, and vitrectomy. In addition, multimodal imaging of DME eyes may be advantageous in predicting the responsiveness to treatment; this is beneficial when initiating alternative therapies. We explore the literature on persistent DME regarding its defining criteria, incidence, the baseline biological markers that may be useful in anticipating the response to treatment, and the available treatment options.     

Impact of systemic parameters before commencing anti-vascular endothelial growth factor therapy for diabetic macular edema – Pan-Indian survey of retina specialists

Purpose:Intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy has emerged as the mainstay of treatment in the management of diabetic macular edema (DME) today. Various systemic risk factors have to be considered before initiating anti-VEGF therapy. The aim of our study was to form a consensus on various systemic factors to consider before starting anti-VEGF therapy for DME.Methods:A questionnaire was created and sent across to various retina specialists across India. A Google™ form with various questions pertaining to what systemic parameters would one consider before giving anti-VEGF therapy for DME was sent to each of them by email/WhatsApp™/direct telephonic interview.Results:Of the 650 retina specialists contacted, 322 responded to the questionnaire. There was no difference in responses between private and institutional practitioners. The majority would consider RBS (85%), HbA1c (61%), blood pressure (63%), and renal function (57%) as a routine before administering the anti-VEGF injection, while the majority would not consider hemoglobin (63%) or lipid profile (55%) of the patient as a routine practice prior to administering the injection.Conclusion:In our study, most VR specialists prefer to consider RBS, HbA1c, BP, and renal profile (creatinine) routinely prior to anti-VEGF injection. We suggest that it is important to consider blood pressure control, glycemic control, HbA1c, Hb, lipid profile, and renal profile (UACR, eGFR, and creatinine) prior to anti-VEGF therapy in all diabetic patients and to discuss the need for statins in patients with dyslipidemias with the physician.     

抗血管内皮生长因子药物治疗糖尿病视网膜病变的研究现状

糖尿病可引起眼内血管内皮生长因子（vascularendothelialgrowthfactor,VEGF）水平病理性升高,导致眼内新生血管形成、黄斑水肿的发生。抗VEGF药物最早被用于湿性年龄相关性黄斑变性,现也被试验性地用于糖尿病视网膜病变（diabeticretinopathy,DR）。VEGFl65选择性拮抗剂Pe—gaptanib与VEGF—A单抗Ranibizumab被批准玻璃体内注射,且对DR有较好的疗效;VEGF．A全长抗体Bevacizumab被标示外用于玻璃体内注射治疗DR,也能达到较好的效果;重组融合蛋白Aflibercept针对DR的疗效也得到一些试验的支持。玻璃体内注射抗VEGF药物治疗DR已被证实短期有效且安全,但其长期的疗效与安全性有待更多的大规模临床试验来验证。     

糖尿病黄斑水肿治疗方案的选择及需要关注的几个问题

糖尿病黄斑水肿(DME)是引起糖尿病患者视力障碍的常见原因,DME易复发,治疗效果不尽如人意,其治疗研究的进展一直受到眼科医师的关注.目前,在国内外关于DME的治疗指南中均已将抗血管内皮生长因子(VEGF)疗法作为一线的或核心的治疗方法,该疗法在临床上已广泛使用.但在临床实践中我们发现,DME治疗方法的选择和实施仍有不明确之处,同时也存在一定的争议,包括DME的治疗目标、疗效的判断指标、对国内外指南的解读、抗VEGF疗法的实施方案、传统激光光凝的作用和临床价值、糖皮质激素类药物的应用方法、复发性DME的处理原则等.近年来针对DME治疗的药物研究仍在进行并取得了一定进展,只有跟踪相关的研究成果,不断完善DME的治疗方法,充分了解不同药物和不同治疗方案的优势和缺点,规范治疗流程,才能最大程度地发挥各种治疗方法或联合疗法对DME的治疗作用.     

Evidence for Anti-VEGF Treatment of Diabetic Macular Edema

Diabetic macular edema (DME) is the most important cause of vision loss in patients with diabetes mellitus. Diabetic retinopathy has a remarkable impact on public health and on the quality of life of diabetic patients and thus requires special consideration. The first line of treatment remains the management of systemic risk factors but is often insufficient in controlling DME and currently, laser retinal photocoagulation is considered the standard of care. However, laser treatment reduces the risk of moderate visual loss by approximately 50% without guaranteeing remarkable effects on visual improvement. For these reasons, new strategies in the treatment of DME have been studied, in particular the use of anti-vascular endothelial growth factor (anti-VEGF) drugs. VEGF is a pluripotent growth factor that acts as a vasopermeability factor and an endothelial cell mitogen. For this reason, it represents an interesting candidate as a therapeutic target for the treatment of DME. The aim of this article is to review the evidence behind the use of anti-VEGF drugs in the treatment of DME.     

Novel pharmacotherapies in diabetic retinopathy: Current status and what's in the horizon?

The blood–retinal barrier (BRB) alteration is the hallmark feature of diabetic retinopathy. Vascular endothelial growth factor (VEGF) is a potent vasopermeability factor that has been implicated in the pathogenesis of BRB alteration. Inflammation also plays a crucial role in this process with involvement of several chemokines and cytokines. Multiple anti-VEGF drugs are widely used as in the treatment of diabetic macular edema (DME) as well as proliferative diabetic retinopathy. Several clinical trials have proved the beneficial effects of these drugs in improvement of vision and prevention of vision loss. However, the response to anti-VEGF drugs in DME is not complete in a significant number of patients. The effect seems transient in this latter group, and many patients do not show complete resolution of fluid. Potential novel therapies targeting molecules beyond VEGF are being developed and examined in clinical trials.     

人工智能在干眼临床诊断中的应用专家共识（2023）

干眼作为一种常见的眼科疾病，患病率高，涉及人群广。随着人工智能(AI)计算机图像技术的兴起、算法模型的改进和医学大数据的海量增长，技术，包括以深度学习(DL)为热门技术的机器学习(ML)技术在医疗领域获得了广泛的应用。AI系统具有先进的问题求解能力和稳定的可重复性，因此，医学领域使用此类技术可以帮助临床医生作出更加客观的诊断。AI在医学上应用取得的成功主要是基于ML这一分支领域的广泛应用，ML技术主要被用来分析患者数据和医学图像中的关键特征，以辅助疾病诊断、严重程度分级和预后判断。AI在眼科学领域的应用已取得显著进展。本文就AI、ML和DL在干眼诊断中的临床应用形成共识，为AI在干眼中的进一步研究和应用提供参考。     

重视糖尿病黄斑水肿的个体化治疗

糖尿病黄斑水肿(DME)是糖尿病患者最常见的严重威胁视功能的视网膜病变,是工作年龄段人群致盲的主要原因。抗VEGF药物是治疗DME的一线药物,在改善视功能方面具有革命性意义。然而,仍有30%~50%的患者对抗VEGF药物治疗无应答,且频繁的注射给患者和社会带来了巨大的治疗负担。新的治疗策略包括改善抗VEGF药物的疗效和持续时间、靶向炎症、血浆激肽-激肽释放酶系统、血管生成素-Tie2系统和神经变性等新治疗途径以及使用阈值下微脉冲激光和靶向激光治疗。确定对抗VEGF药物治疗无应答的病例,建立从抗VEGF药物治疗到抗炎等替代治疗的标准化、个体化治疗方案目前仍具有挑战性,仍需继续研究开发新的治疗方法以及预防和筛查策略,以减少糖尿病视网膜病变和DME对公众健康的影响。     

糖尿病性黄斑水肿患者抗VEGF药物疗效与尿蛋白含量的相关性研究

目的　观察不同尿蛋白含量下糖尿病性黄斑水肿(diabetic macular edema，DME)患者行抗血管内皮生长因子（vascular endothelial growth factor，VEGF）药物治疗的疗效差异并进行影响因素分析。方法　前瞻性研究。选取2018年1月至2018年12月于南昌大学第二附属医院内分泌科及眼科住院或门诊已确诊为2型DME患者82例，根据尿肾功能检查结果将患者分为三组:尿白蛋白含量小于30 mg为正常蛋白尿组（19例），尿白蛋白含量30~300 mg为微量蛋白尿组（16例），尿白蛋白含量大于300 mg为大量蛋白尿组（47例）。收集患者年龄、糖尿病病程、高血压病史、肾功能检验结果［尿蛋白、尿微量白蛋白、N-乙酰-β-D-氨基葡萄糖苷(N-acetyl-β-D-glucosaminidase，NAG）酶］、血生化检验结果［血肌酐、估算肾小球滤过率（estimated glomerular filtration rate,EGFR）、糖化血红蛋白、糖尿病视网膜病变程度、基线最佳矫正视力（best corrected visual acuity，BCVA）、基线黄斑中心凹视网膜厚度（center macular thickness，CMT）。所有患眼玻璃体内注射康柏西普，均为每月注射1次，连续注射3次，随访3个月。对比分析三组患者治疗后1周、1个月、2个月、3个月的BCVA及CMT资料；以CMT降低≥20％为黄斑水肿消退疗效敏感，反之为疗效不敏感；以BCVA提高2行及以上为视力提高疗效敏感，反之为疗效不敏感。单因素及二分类Logistics回归分析影响三组患者行抗VEGF药物治疗后视力提高疗效及水肿消退疗效的因素。结果　三组患者行抗VEGF治疗后1周、1个月、2个月、3个月的视力提高疗效、黄斑水肿消退疗效敏感率正常蛋白尿组为68.0％、100.0％、94.7％、94.7％和10.5％、73.7％、100.0％、100.0％，微量蛋白尿组为50.0％、87.5％、87.5％、87.5％和0、62.5％、87.5％、93.8％，大量蛋白尿组为19.0％、42.6％、42.6％、31.9％和0、25.5％、36.2％、23.4％；尿蛋白含量越低，治疗后视力提高疗效、黄斑水肿消退疗效越敏感；三组患者治疗后不同时间点的视力提高疗效、黄斑水肿消退疗效差异均有统计学意义（均为P<0.05）。单因素分析结果显示，EGFR、尿蛋白、尿微量白蛋白、NAG酶、糖尿病病程、蛋白尿分组、基线CMT与治疗后3个月视力提高疗效均有关（均为P<0.05）；血肌酐、EGFR、尿蛋白、尿微量白蛋白、NAG酶、高血压、蛋白尿分组、基线CMT与患者治疗后3个月的黄斑水肿消退疗效均有关（均为P<0.05）；二分类Logistics回归分析结果显示，尿蛋白含量是影响DME患者行抗VEGF治疗后3个月视力提高疗效（OR=1.03，95％CI为1.01~1.12）及黄斑水肿消退疗效（OR=1.21，95％CI为1.09~1.43）的独立危险因素（均为P<0.05）。结论　DME患者尿蛋白含量越低，经抗VEGF药物治疗后视力提高疗效、黄斑水肿消退疗效越好，尿蛋白水平高是DME患者行抗VEGF药物疗效的独立危险因素。     

氩激光治疗黄斑水肿影响因素的临床观察

目的 :本研究探讨了氩激光治疗糖尿病黄斑水肿中几种因素对治疗效果的影响。方法 :对 3 9例 45眼接受激光治疗的病人行回顾性观察 ,对可能影响治疗效果的几种因素进行统计学分析。结果 :黄斑水肿治疗效果与年龄和HbA1c水平成负相关 (P <0 0 1) ,而与血糖水平和病程无显著相关 ;黄斑水肿分型与治疗效果密切相关。结论 :糖尿病黄斑水肿激光治疗预后与年龄、糖化血红蛋白 (HbA1c)水平和黄斑水肿分型有关。HbA1c是一项较血糖更能代表糖尿病控制的重要指标。     

Application and progress of artificial intelligence technology in the segmentation of hyperreflective foci in OCT images for ophthalmic disease research

With the advancement of retinal imaging, hyperreflective foci (HRF) on optical coherence tomography (OCT) images have gained significant attention as potential biological biomarkers for retinal neuroinflammation. However, these biomarkers, represented by HRF, present pose challenges in terms of localization, quantification, and require substantial time and resources. In recent years, the progress and utilization of artificial intelligence (AI) have provided powerful tools for the analysis of biological markers. AI technology enables use machine learning (ML), deep learning (DL) and other technologies to precise characterization of changes in biological biomarkers during disease progression and facilitates quantitative assessments. Based on ophthalmic images, AI has significant implications for early screening, diagnostic grading, treatment efficacy evaluation, treatment recommendations, and prognosis development in common ophthalmic diseases. Moreover, it will help reduce the reliance of the healthcare system on human labor, which has the potential to simplify and expedite clinical trials, enhance the reliability and professionalism of disease management, and improve the prediction of adverse events. This article offers a comprehensive review of the application of AI in combination with HRF on OCT images in ophthalmic diseases including age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO) and other retinal diseases and presents prospects for their utilization.     

玻璃体腔内注射抗VEGF对糖尿病性黄斑水肿患者脉络膜厚度的影响

目的:使用光学相干断层扫描(OCT)研究累及中心凹的糖尿病性黄斑水肿(DME)患者玻璃体腔内注射雷珠单抗或阿柏西普后中心凹下脉络膜厚度的变化。方法:纳入本院确诊累及中心凹的DME患者17例,其中玻璃体腔内注射雷珠单抗0.5mg/0.05mL患者9例,玻璃体腔内注射阿柏西普2mg/0.05mL患者8例,所有患者均接受每月1次,共3次治疗。使用增强深度成像-光学相干层析成像(EDI-OCT)观察两组患者治疗前和治疗后1mo中心凹下脉络膜厚度、视力和视网膜中央厚度的变化情况。结果:两组患者通过3次玻璃体腔注射抗VEGF后,中心凹下脉络膜厚度和视网膜中央厚度明显较治疗前变薄,视力较治疗前明显改善(均P<0.05),而两组间中心凹下脉络膜厚度、视网膜中央厚度和视力比较均无差异(均P>0.05)。治疗前中心凹下脉络膜厚度与视力改善之间无明显相关性(r_s=-0.269,P=0.296)。治疗后脉络膜厚度变化与视力改善、视网膜中央厚度变化以及患者年龄之间均无明显相关性(均P>0.05)。结论:玻璃体腔内注射雷珠单抗和阿柏西普均可以使累及中心凹的DME患者中央凹下脉络膜和视网膜中央厚度变薄并显著改善视力。     

Research progress in artificial intelligence assisted diabetic retinopathy diagnosis

Diabetic retinopathy (DR) is one of the most common retinal vascular diseases and one of the main causes of blindness worldwide. Early detection and treatment can effectively delay vision decline and even blindness in patients with DR. In recent years, artificial intelligence (AI) models constructed by machine learning and deep learning (DL) algorithms have been widely used in ophthalmology research, especially in diagnosing and treating ophthalmic diseases, particularly DR. Regarding DR, AI has mainly been used in its diagnosis, grading, and lesion recognition and segmentation, and good research and application results have been achieved. This study summarizes the research progress in AI models based on machine learning and DL algorithms for DR diagnosis and discusses some limitations and challenges in AI research.     

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.     

糖尿病黄斑水肿患者白内障围手术期应用抗VEGF药物的疗效观察

目的 观察糖尿病黄斑水肿(DME)患者真实世界中白内障手术前后玻璃体内注射抗血管内皮生长因子(VEGF)药物的效果,进而观察DME患者白内障围手术期积极接受玻璃体内注射抗VEGF药物疗效.方法 回顾性临床队列研究.回顾性分析2018年1月至2021年5月在郑州大学第一附属医院眼二科接受白内障超声乳化手术和玻璃体内注射抗...     

新型双特异性单抗Faricimab治疗糖尿病性黄斑水肿及年龄相关性黄斑变性的研究进展

糖尿病性黄斑水肿(DME)和年龄相关性黄斑变性(ARMD)是世界范围内视力损害和失明的主要原因，二者共同的病理特征是血管通透性增加和异常新生血管，血管内皮生长因子(VEGF)及血管生成素-2(Ang-2)等细胞因子在其中起着重要作用。抗VEGF制剂玻璃体内注射显著改变了DME和ARMD的临床管理，但无反应病例的存在、频繁注射带来的治疗负担及风险等局限性需要克服。Faricimab是一种同时靶向阻断VEGF-A和Ang-2的新型双特异性单抗，可有效降低血管通透性、减少新生血管数量和减轻视网膜水肿。注册临床研究显示Faricimab可有效改善视力和消退视网膜积液，相较于阿柏西普和雷珠单抗具有非劣效性，能维持较长的给药间隔，同时具有较高的安全性。本文就Faricimab在DME和ARMD治疗中的最新进展做一综述。