Updates on medical and surgical managements of diabetic retinopathy and maculopathy

IF 3.7 3区医学 Q1 OPHTHALMOLOGY

Asia-Pacific Journal of Ophthalmology Pub Date : 2025-03-01 DOI:10.1016/j.apjo.2025.100180

Yen-Ting Chen , Nishant V. Radke , Sohani Amarasekera , Dong Ho Park , Nelson Chen , Jay Chhablani , Nan-Kai Wang , Wei-Chi Wu , Danny S.C. Ng , Pramod Bhende , Shobhit Varma , Enne Leung , Xiulan Zhang , Fei Li , Shaochong Zhang , Dong Fang , Jia Liang , Zheming Zhang , Huanyu Liu , Peiquan Zhao , Dennis S.C. Lam

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引用次数: 0

Abstract

Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss globally. This is a comprehensive review focused on both medical and surgical management strategies for DR and DME. This review highlights the epidemiology of DR and DME, with a particular emphasis on the Asia-Pacific region, urban-rural disparities, ethnic variations, and grading methodologies. We examine various risk factors for DR, including glycemic control, hypertension, hyperlipidemia, obesity, chronic kidney disease, sex, myopia, pregnancy, and cataract surgery. Furthermore, we explore potential biomarkers in serum, proteomics, metabolomics, vitreous, microRNA, and genetics that may aid in the detection and management of DR. In addition to medical management, we review the evidence supporting systemic and ocular treatments for DR/DME, including anti–vascular endothelial growth factor (anti-VEGF) agents, anti-inflammatory agents, biosimilars, and integrin inhibitors. Despite advancements in treatment options such as pan-retinal photocoagulation and anti-VEGF agents, a subset of cases still progresses, necessitating vitrectomy. Challenging diabetic vitrectomies pose difficulties due to complex fibrovascular proliferations, incomplete posterior vitreous detachment, and fragile, ischemic retinas, making membrane dissection risky and potentially damaging to the retina. In this review, we address the question of challenging diabetic vitrectomies, providing insights and strategies to minimize complications. Additionally, we briefly explore newer modalities such as 3-dimensional vitrectomy and intra-operative optical coherence tomography as potential tools in diabetic vitrectomy. In conclusion, this review provides a comprehensive overview of both medical and surgical management options for DR and DME. It underscores the importance of a multidisciplinary approach, tailored to the needs of each patient, to optimize visual outcomes and improve the quality of life for those affected by these sight-threatening conditions.

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糖尿病视网膜病变和黄斑病变的内科和外科治疗进展。

糖尿病视网膜病变（DR）和糖尿病黄斑水肿（DME）是全球视力丧失的主要原因。这是一篇全面的综述，重点是DR和DME的医学和外科治疗策略。本综述强调DR和DME的流行病学，特别强调亚太地区、城乡差异、种族差异和分级方法。我们研究了DR的各种危险因素，包括血糖控制、高血压、高脂血症、肥胖、慢性肾脏疾病、性别、近视、怀孕和白内障手术。此外，我们探索了血清、蛋白质组学、代谢组学、玻璃体、microRNA和遗传学中的潜在生物标志物，这些生物标志物可能有助于DR/DME的检测和管理。除了医学管理，我们回顾了支持DR/DME的全身和眼部治疗的证据，包括抗血管内皮生长因子（anti-VEGF）药物、抗炎药物、生物仿制药和整合素抑制剂。尽管泛视网膜光凝和抗vegf药物等治疗方案取得了进展，但仍有一部分病例仍在进展，需要进行玻璃体切除术。由于复杂的纤维血管增生、不完全的玻璃体后脱离和脆弱的缺血性视网膜，使得膜剥离具有风险并可能对视网膜造成损害，因此具有挑战性的糖尿病玻璃体切除术存在困难。在这篇综述中，我们讨论了具有挑战性的糖尿病玻璃体切除术的问题，提供了最小化并发症的见解和策略。此外，我们简要地探讨了新的模式，如三维玻璃体切除术和术中光学相干断层扫描作为糖尿病玻璃体切除术的潜在工具。总之，这篇综述提供了DR和DME的内科和外科治疗方案的全面概述。它强调了多学科方法的重要性，根据每位患者的需求量身定制，以优化视力结果并改善受这些视力威胁条件影响的患者的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asia-Pacific Journal of Ophthalmology OPHTHALMOLOGY-

CiteScore

8.10

自引率

18.20%

发文量

197

审稿时长

6 weeks

期刊介绍： The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.