无糖尿病性黄斑水肿(DME)的非增殖性(NPDR)和增殖性糖尿病视网膜病变(PDR)影响全世界数百万患有糖尿病的个体。有关此类患者的各种管理策略的数据越来越多,但在如何将这些数据应用于临床实践方面的共识有限.
■本文献综述和社论介绍并综合了当前关于无DME的NPDR和PDR的各种管理范例的证据。
■视网膜专家是糖尿病管理团队不可或缺的成员,并应鼓励患者注意血糖和心血管优化对减少系统性和视网膜病变危险因素的重要性。糖尿病视网膜病变严重程度量表(DRSS)现在是美国临床试验的可批准终点,因此变得更具临床相关性。对于不带DME的PDR,糖尿病视网膜病变研究(DRS)和糖尿病视网膜病变早期治疗研究(ETDRS)建立了全视网膜光凝(PRP)治疗标准.此后,激光参数已发展为包括强度较低且较早的干预。最近的研究表明,PDR的抗血管内皮生长因子(VEGF)治疗可有效缓解许多患者的新生血管形成并改善DRSS水平。需要进一步的证据来确定最佳治疗频率,持续时间,和再治疗标准,在现实世界中。在抗VEGF治疗期间失去随访的患者中存在不良事件的担忧。对于没有DME的NPDR,护理标准是一种观望的方法。DRS和ETDRS中的数据表明,用于重度NPDR的PRP也可以作为选择患者的选择。多项临床试验现已证明抗VEGF治疗可以改善NPDR的DRSS评分。需要进一步的研究来评估这是否会对长期视力产生积极影响。以及日常使用的好处是否大于现实世界中的风险。
■有累积证据表明,对于无DME的NPDR和PDR,各种治疗方案的有效性。目前,患者最有可能受益于针对个体患者量身定制的周到管理策略.
UNASSIGNED: Nonproliferative (NPDR) and proliferative diabetic retinopathy (PDR) without diabetic macular edema (DME) affect millions of individuals living with diabetes throughout the world. There is increasing data on various management strategies for such patients, but there is limited
consensus on how the data should be adopted into clinical practice.
UNASSIGNED: This literature review and editorial presents and synthesizes the current evidence for various management paradigms for NPDR and PDR without DME.
UNASSIGNED: Retina specialists are an integral member of the diabetes management team, and should encourage patients on the importance of glycemic and cardiovascular optimization for both systemic and retinopathy risk factor reduction. The diabetic retinopathy severity scale (DRSS) is now an approvable endpoint for clinical trials in the United States, therefore becoming more clinically relevant. For PDR without DME, the Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS) established the standard of care with panretinal photocoagulation (PRP). Laser parameters have since evolved to include less intense and earlier intervention. Studies have recently demonstrated that anti-vascular endothelial growth factor (VEGF) treatment of PDR is effective at regressing neovascularization and improving DRSS levels in many patients. Further evidence is required to determine optimal treatment frequency, duration, and retreatment criteria, in the real world. There are concerns for adverse events in patients being lost to follow up during anti-VEGF treatment. For NPDR without DME, the standard of care has been a wait-and-watch approach. Data within the DRS and the ETDRS suggest that PRP for severe NPDR can be an option for select patients as well. Multiple clinical trials have now demonstrated that anti-VEGF treatment can improve the DRSS score in NPDR. Further studies are required to assess whether this positively affects long-term visual outcomes, and whether the benefits outweigh the risks in the real world for routine use.
UNASSIGNED: There is cumulative evidence demonstrating the efficacy of various treatment options for NPDR and PDR without DME. Currently, patients would most likely benefit from thoughtful management strategies that are tailored to the individual patient.