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NR 7-9/2008
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Rola nabłonka
barwnikowego siatkówki w patogenezie cukrzycowego obrzęku plamki
i jego leczeniu
Role of the retinal pigment
epithelium (RPE) in the pathogenesis and treatment of diabetic
macular edema (DME)
Katarzyna Chmielewska, Jacek
Robaszkiewicz, Mariusz Kosatka
Z Kliniki Okulistycznej Wojskowego Instytutu Medycyny w
Warszawie
Kierownik: prof. dr hab. n. med. Andrzej Stankiewicz |
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| Summary: |
Pigment epithelium-derived
factor (PEDF) has recently been shown to be the most
potent inhibitor of angiogenesis in the mammalian eye,
suggesting that loss of PEDF is involved in the
pathogenesis of proliferative diabetic retinopathy.
However, a protective role for PEDF in pericyte loss
requires elucidation. Present studies suggest that PEDF
proteins could protect against advanced glycation end
product (AGE), which induce injury in retinal pericytes.
Substitution of PEDF proteins may be a promising
strategy in the treatment of patients with early
diabetic retinopathy. Therefore, injury of RPE is the
basic condition, not only of the progress of
neovascularization, but initiation of early diabetic
microangiopathy and macular edema as well. Recently new
intravitreal drugs being used in the treatment of eye
diseases with increased level of VEGF. Intravitreally
administered a human, monoclonal anti-VEGF agent acts
only as symptomatic treatment. It does not eliminate
hypoxia and requires repeated administration. It is
worth emphasizing, that VEGF functions are not limited
to active angiogenesis, but also seems to require the
maintenance and differentiation of mature blood vessels,
such as the choriocapillaris. Therefore, delivery of
these anti-VEGF treatments needs to be specific to sites
of neovascularization or limited to a short duration, to
prevent disruption of the normal vasculature. The
effective method, which preserves RPE, improves
oxygenation and release traction on the macula, leading
to decreased permeability with subsequent resolution in
DME, is pars plana vitrectomy with ILM peeling. There
are several investigations that support the theoretical
value of vitrectomy for the treatment of DME.
Intraoperative administration of anti-VEGF agent and
corticosteroids may additionally improve results of
operative treatment. |
| Słowa kluczowe: |
czynnik pochodzący z
nabłonka barwnikowego siatkówki, naczyniowo-śródbłonkowy
czynnik wzrostu, retinopatia cukrzycowa, cukrzycowy
obrzęk plamki, witreoretinopatia proliferacyjna,
mezenchymalne odróżnicowanie komórek nabłonka, pars
plana witrektomia, usunięcie ILM. |
| Key words: |
pigment epithelium-derived
factor, vascular endothelial growth factor, diabetic
retinopathy, diabetic macular edema, proliferative
vitreoretinopathy, epithelial-mesenchymal transition,
pars plana vitrectomy, ILM peeling. |
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