抗VEGF时代激光光凝治疗糖尿病视网膜病变的应用进展

Application progress of laser photocoagulation in diabetic retinopathy treatment in the era of anti-vascular endothelial growth factor agents

摘要:

糖尿病视网膜病变(DR)是糖尿病患者最普遍和最严重的眼部并发症，也是成人失明的主要原因之一。近年来，以抗血管内皮生长因子(VEGF)制剂为代表的药物治疗已成为DR的一线疗法，但不能逆转视网膜无灌注区、微动脉瘤和毛细血管异常扩张，不能按时接受治疗者有病情进展风险。激光疗法的广泛应用已有40多年历史，可通过消除毛细血管无灌注区，有效降低致盲率，其中广泛视网膜光凝治疗(PRP)一直是DR的主要治疗方法。激光技术不断改进和发展，在保持疗效的基础上，实现了视网膜损害与副作用最小化的目标。通过联合抗VEGF制剂，可实现优势互补，达到更佳疗效。加深对激光及激光联合抗VEGF制剂治疗DR的临床研究，有助于建立符合我国国情的个性化治疗方案。本文就抗VEGF时代激光在DR治疗中的应用进展进行简要综述。

Abstract:

Diabetic retinopathy(DR)is the most prevalent and severe ocular complication in people with diabetes, and it is one of the leading causes of blindness in adults. In recent years, drug therapy represented by anti-vascular endothelial growth factor(VEGF)agents has become the first-line therapy in DR treatment, but it cannot reverse retinal non-perfusion areas, microaneurysms and abnormal teleangiectatic capillaries, those who cannot be treated on time are at risk of disease progression. Laser photocoagulation has been widely applied for more than 40 years, it can effectively reduce the rate of blindness by eliminating the non-perfusion areas of capillaries, and panretinal photocoagulation(PRP)has been the primary treatment for DR. With the continuing innovations in laser technology, on the basis of maintaining the curative effect, the aim of minimizing retinal damage and adverse side effects has been realized. A combination of laser photocoagulation and anti-VEGF agents can achieve complementary advantages and better efficacy. Deepening the clinical research on laser therapy and laser therapy combined with anti-VEGF agents in the treatment of DR may help to establish the personalized treatment corresponds with our national conditions. This article briefly reviews the latest application progress of laser therapy in DR treatment in the era of anti-VEGF agents.