中华眼底病杂志

中华眼底病杂志

重视对糖尿病黄斑水肿的诊治

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糖尿病黄斑水肿(DME)是导致糖尿病视网膜病变(DR)患者视功能损害的主要原因。DME主要包括局灶型DME和弥漫型DME;有临床意义的DME(CSME)需及时干预治疗。光相干断层扫描是目前公认的可精确诊断DME的最灵敏方法。DME常用治疗方法包括玻璃体腔注射抗血管内皮生长因子(VEGF)药物、糖皮质激素以及激光光凝治疗等,其中玻璃体腔注射抗VEGF药物逐步成为一线治疗方案;同时应根据DME特征以及患者的具体情况选择相应治疗或联合治疗方案。在DME诊治过程中需重视糖尿病的全身治疗,及其引起的神经视网膜病变对DME的治疗效果产生的影响。随着抗VEGF药物疗效的异质性显现,如何选择替代药物以及何时替换药物,仍需深入研究。

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy patients. It mainly includes focal DME and diffuse DME, while DME of clinical significance needs timely intervention treatment. Optical coherence tomography is currently recognized as the most sensitive method to accurately diagnose DME. Currently, the common treatments of DME include intravitreal injection of anti-vascular endothelial growth factor (VEGF) or glucocorticoid and laser photocoagulation. Among them, anti-VEGF injection is becoming the first-line therapeutic, and corresponding individual treatment or combined treatment strategy should be selected according to the characteristics of DME and the specific conditions of patients. During the diagnosis and treatment of DME, attention should be paid to the systemic treatment of diabetes and the effect of diabetes-related neuroretinopathy on the therapeutic effect of DME. With the appearance of heterogeneity in the efficacy of anti-VEGF drugs, it remains to be further studied how to choose alternative therapeutics and when to replace them.

关键词: 黄斑水肿/诊断; 黄斑水肿/治疗; 糖尿病视网膜病变/并发症; 述评

Key words: Macular edema/diagnosis; Macular edema/therapy; Diabetic retinopathy/ complications; Editorial

引用本文: 许迅, 卢一. 重视对糖尿病黄斑水肿的诊治. 中华眼底病杂志, 2018, 34(4): 313-316. doi: 10.3760/cma.j.issn.1005-1015.2018.04.001 复制

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