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。

Attach importance to individualized treatment of diabetic macular edema

Diabetic macular edema(DME)is the most common retinopathy that seriously threatens the visual function of diabetic patients,and it represents a major cause of blindness especially among people in working age.Ocular VEGF inhibitors are most often used as a first line therapy for DME,and have revolutionary significance in improving visual outcomes.However,there remain 30%-50%patients who fail to respond to anti-VEGF treatment,and the need for frequent injections brings a substantial treatment burden to patients and society.Novel therapeutic strategies include improving efficacy and duration of anti-VEGF drugs,targeting inflammation,the plasma kallikrein-kinin system,the angiopoietin-Tie2 system,neurodegeneration and other alternative pathways,as well as using subthreshold and targeted laser therapy.It is still challenging in the individualized management of DME to identify non-responders to anti-VEGF drugs and to establish a standardized regimen for the switch from anti-VEGF therapy to anti-inflammatory or other alternative treatment.Further research and development of new therapies,as well as preventive and screening strategies,are needed to reduce the impact of diabetic retinopathy and DME on public health.