Postępowanie terapeutyczne w retinopatii cukrzycowej
Therapeutic Approach in Diabetic Retionopathy
Anna I. Borucka, Jerzy Szaflik
Katedra i Klinika Okulistyki II Wydziału Lekarskiego Akademii Medycznej w Warszawie Samodzielny Publiczny Kliniczny Szpital Okulistyczny w Warszawie Kierownik: prof. dr hab. n. med. Jerzy Szaflik
Summary: Diabetic retinopathy remains one of the leading causes of blindness worldwide. The duration of diabetes and severity of hyperglycaemia are the major risk factors. Strict metabolic control and blood pressure control can significantly reduce the risk retinopathy development and progression, but are difficult to achieve in clinical practice. Laser photocoagulation remains the principal therapy for sight-threatening diabetic retinopathy. For severe complications of the proliferative diabetic retinopathy vitrectomy remains the treatment of choice. The intravitreal injection of slow-release steroid, which suppresses inflammation, reduces extravasation from leaking blood vessels and inhibits fibro-vascular proliferation, has emerged as a promising therapy for diabetic macular edema refractory to conventional laser photocoagulation. Vascular endothelial growth factor (VEGF) is produced in response to hypoxia from capillary loss. It is a key mediator of angiogenesis and blood-retinal barrier breakdown in ischaemic retina. VEGF activity inhibition may play a pivotal role in the proliferative diabetic retinopathy prevention. Currently, there are three main anti-VEGF agents: pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin). Conservative therapy in diabetic retinopathy plays only an adjunctive role. Further clinical trials are exploring the role of new additional treatments for reduction in the visual loss frequency due to the diabetic retinopathy (protein C inhibitors, growth hormone, Cyclooxygenase (COX)-2 inhibitor, aldose reductase inhibitors, advanced glycation end-products (AGE) inhibitor, high-dose aspiryn).
Keywords: diabetic retinopathy, nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser coagulation, vitrectomy, glycaemia control, blood pressure control, lipid control, vascular endothelial growth factor, triamcinolone acetonide, dexame