糖尿病性黄斑水肿的外科治疗。

IF 5.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Jamie Prince, Dipen Kumar, Arko Ghosh, J Fernando Arevalo, Alice Yang Zhang
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引用次数: 0

摘要

综述目的:糖尿病性黄斑水肿(DME)是黄斑细胞外空间积液,是糖尿病患者视力受损的主要原因。二甲醚的一线治疗包括玻璃体内抗血管内皮生长因子药物和玻璃体内皮质类固醇药物治疗。其他治疗策略包括激光光凝治疗非中心性二甲醚,手术治疗如玻璃体部分玻璃体切除术(PPV)伴有或不伴有内限制膜(ILM)剥离的玻璃体视网膜界面异常或药物治疗难治的二甲醚,以及Port Delivery System (PDS)用于持续释放抗血管内皮生长因子(VEGF)药物。我们的目的是回顾二甲醚手术治疗的现有文献,包括慢性二甲醚的影像学改变和手术干预的临床意义。最近发现:与DME相关的影像学改变和较差的预后包括视网膜层紊乱,外限制膜(ELM)和椭球带破坏,以及玻璃体黄斑界面异常。有和没有ILM剥离的玻璃体部切除术的研究显示解剖改善,但可能并不总是与视力结果的显着变化相关。早期的研究缺乏视网膜层的详细成像,PPV可能是最后的手段。此外,新型PDS通过手术植入到计划部,作为药物储存库,控制药物释放。然而,由于脱位问题,它已被召回用于湿性年龄相关性黄斑变性患者。DME的手术干预措施包括带或不带ILM剥离的玻璃体切除,DME的新手术治疗方法如PDS和视网膜下基因治疗有可能降低DME进展的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Surgical Management of Diabetic Macular Edema.

Surgical Management of Diabetic Macular Edema.

Purpose of review: Diabetic macular edema (DME) is the accumulation of fluid in the extracellular space within the macula and is a major cause of visual impairment among patients with diabetes. First-line treatment for DME includes pharmacotherapy with intravitreal anti-vascular endothelial growth factor medications and intravitreal corticosteroids. Alternative therapeutic strategies include laser photocoagulation for non-center involving DME, and surgical options such as pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peel in cases with vitreoretinal interface anomalies or DME refractory to pharmacotherapy, and the Port Delivery System (PDS) for sustained release of anti-vascular endothelial growth factor (VEGF) medication. Our aim is to review the existing literature on surgical management of DME including imaging changes in chronic DME and the clinical relevance of surgical intervention.

Recent findings: Imaging changes associated with DME and a worse prognosis include disorganization of the retinal layer, disruption of both the external limiting membrane (ELM) and ellipsoid zone, and vitreomacular interface abnormalities. Studies involving pars plana vitrectomy with and without ILM peel show anatomic improvement but may not always be associated with significant change in visual outcomes. Early studies lacked detailed imaging of the retinal layers and PPV was likely performed as a last resort. In addition, the novel PDS is surgically implanted into the pars plana and works as a drug reservoir with controlled release of drug. However, it has been recalled in patients with wet age-related macular degeneration due to issues with dislodgement. Surgical interventions for DME include pars plana vitrectomy with and without ILM peel and new surgical therapies for DME such as the PDS and subretinal gene therapy have the potential to reduce the risk of DME progression.

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来源期刊
CiteScore
9.80
自引率
0.00%
发文量
52
审稿时长
6-12 weeks
期刊介绍: The goal of this journal is to publish cutting-edge reviews on subjects pertinent to all aspects of diabetes epidemiology, pathophysiology, and management. We aim to provide incisive, insightful, and balanced contributions from leading experts in each relevant domain that will be of immediate interest to a wide readership of clinicians, basic scientists, and translational investigators. We accomplish this aim by appointing major authorities to serve as Section Editors in key subject areas across the discipline. Section Editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year on their topics, in a crisp and readable format. We also provide commentaries from well-known figures in the field, and an Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.
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