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Management of proliferative DR

机译：增殖性DR的管理

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ADVANCES IN MEDICAL MANAGEMENT: RECENT TRIALSPanretinal photocoagulation (PRP) has been the standard treatment for PDR for over four decades and reduces the risk of severe visual loss by 50%.2 However, PRP can cause permanent peripheral visual field loss, decreased night vision and may exacerbate diabetic macular edema (DME). Even with timely PRP treatment, about 5% of eyes with PDR develop severe vision loss.1Anti-VEGF agents have been shown to cause short-term new vessel regression and reduce the risk of diabetic retinopathy becoming worse, making these agents a potentially viable PDR treatment. Bevacizumab (Avastin, Genentech Inc.), ranibizumab (Lucentis, Genentech Inc.) and aflibercept (Regeneron) have been studied in PDR.3 Two large randomized clinical trials have shown the benefits of anti-VEGF compared with PRP — the U.S. Diabetic Retinopathy Clinical Research (DRCR) Network Protocol S and the UK CLARITY trial.4 The DRCR.net showed that compared to PRP, patients in the ranibizumab arm had less visual field loss, better visual acuity over two years, and fewer vitrectomies.5The CLARITY trial showed that at one year, patients taking aflibercept had an improved outcome compared to PRP. Anti-VEGF agents also have a disease-modifying effect in terms of improvement in both DME and diabetic retinopathy severity score (DRSS).6, 7 This is important because DRSS improvement correlates with both functional and anatomic improvement.
机译：在医学管理方面的进展：最近的临床研究视网膜光凝术（PRP）成为PDR的标准治疗方法已有40多年了，可将严重视力丧失的风险降低50％。2但是，PRP可导致永久性周边视野丧失，夜视能力下降和可能会加剧糖尿病性黄斑水肿（DME）。即使采用及时的PRP治疗，约5％的PDR眼也会出现严重的视力丧失。1已显示抗VEGF药物可引起短期新血管退化，并降低糖尿病性视网膜病变的风险，使这些药物成为潜在可行的PDR治疗。在PDR中对贝伐单抗（Avastin，Genentech Inc.），兰尼单抗（Lucentis，Genentech Inc.）和阿柏西普（Regeneron）进行了研究。3两项大型随机临床试验表明，抗VEGF的益处比PRP（美国糖尿病性视网膜病）好。临床研究（DRCR）网络协议S和UK CLARITY试验。4DRCR.net显示，与PRP相比，兰尼单抗组的患者视野损失更少，两年内视力更好，玻璃体切除术更少。5CLARITY试验研究表明，与PRP相比，服用aiberscept的患者在一年后的结局有所改善。就DME和糖尿病性视网膜病变严重程度评分（DRSS）的改善而言，抗VEGF药物也具有改善疾病的作用。6，7这很重要，因为DRSS改善与功能和解剖学改善都相关。

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