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NR. 2/2007
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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 |
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| 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). |
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| Key words: |
diabetic retinopathy,
nonproliferative diabetic retinopathy, proliferative
diabetic retinopathy, laser coagulation, vitrectomy,
glycaemia control, blood pressure control, lipid
control, vascular endothelial growth factor,
triamcinolone acetonide, dexamethasone, fluocinolone
acetonie, pegaptanib, ranibizumab, bevacizumab,
pharmacotherapy. |
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