抗血管内皮生长因子治疗糖尿病黄斑水肿有效吗?

Kuan Hao Yee, S. Sanjay
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引用次数: 1

摘要

糖尿病性黄斑水肿(DMO)是糖尿病视网膜病变患者常见的眼病,严重威胁视力并导致失明。DMO的金标准治疗是焦/网格激光光凝,实现了疾病进展的稳定。然而,新的药物治疗选择逐渐受到青睐,因为研究表明它们在显著改善视力方面具有优越的功效。特别是,抗血管内皮生长因子(anti-VEGF)的使用已经变得非常流行,从许多关于有效性和安全性的试验中出现了有希望的证据。根据2014年美国视网膜专家协会(ASRS)的偏好和趋势调查,目前首选的DMO一线治疗实际上是抗vegf药物。研究表明,VEGF在DMO发生过程中的血管生成和炎症过程中都起着关键作用。因此,这使得抗vegf药物能够特异性靶向和治疗潜在病理,表明其重要性,并可能解释其疗效。我们评估了记录抗vegf治疗DMO疗效的现有文献。一项关键的临床发现是,抗vegf作为一种药物,在黄斑水肿和视力改善方面取得了优异的效果,并持续了3年,有证据表明也可以持续5年。因此,随着玻璃体内抗vegf治疗的日益普及,DMO患者的长期预后更好,关键的是,进展为失明的可能性降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Oedema: Is It Effective?
Diabetic macular oedema (DMO) is a common ocular problem among patients with diabetic retinopathy, which is sight-threatening and leads to blindness. The gold standard treatment for DMO had been focal/grid laser photocoagulation that achieved stabilisation of disease progression. However, newer pharmacological treatment options have gradually been favoured, as studies demonstrate their superior efficacy with regard to significant visual improvements. In particular, use of anti-vascular endothelial growth factor (anti-VEGF) has become very popular, with promising evidence emerging from numerous trials regarding efficacy and safety. Based on the 2014 American Society of Retina Specialists (ASRS) Preferences and Trends survey, the current preferred first-line therapy for DMO is in fact an anti-VEGF agent. Studies have shown that VEGF plays a critical role in both the angiogenesis and inflammation processes that occur during development of DMO. Hence, this allows anti-VEGF agents to specifically target and treat the underlying pathology, signifying its importance, and possibly accounting for its efficacy. We evaluate the available literature documenting the efficacy of anti-VEGF treatment in DMO. A key clinical finding was that anti-VEGF, as a drug class, achieved superior resolution of macular oedema and visual improvements that were consistently sustainable over 3 years, with some evidence pointing towards 5-year sustainability too. Hence, with intravitreal anti-VEGF treatments increasingly available, better long-term prognosis and, crucially, reduced likelihood of progression to blindness can be expected in patients with DMO.
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