《我国糖尿病视网膜病变临床诊疗指南(2022年)——基于循证医学修订》更新点  

Keypoints in Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)

作　　者：黎晓新[1,2] Li Xiaoxin(Xiamen Eye Center of Xiamen University,Xiamen 361003,China;Department of Ophthalmology,People's Hospital of Peking University,Beijing 100044,China)

机构地区：[1]厦门大学厦门眼科中心,厦门361003 [2]北京大学人民医院眼科,北京100044

出　　处：《中华眼底病杂志》2023年第2期91-94,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：《我国糖尿病视网膜病变临床诊疗指南(2022年)——基于循证医学修订》是基于最近的临床试验提供的数据,并采用证据评价与推荐意见分级、制定和评价(Grading of Recommendations,Assessment,Development and Evaluation)的证据质量和推荐意见强度的评价方法制定的。主要的更新点围绕为什么糖尿病黄斑水肿(DME)的分型不断变化;对于累及黄斑中心凹的DME(CI-DME)但伴有较好视力者,何时能启动抗血管内皮生长因子(VEGF)药物治疗;对于临床有意义的黄斑水肿即使视力较好者,也能进行局部激光光凝;CI-DME的临床治疗路径从激光光凝调整为首先抗VEGF药物治疗;对于非增生型糖尿病视网膜病变(DR)患者,抗VEGF药物加载剂量从3针推荐为4~5针;对于严重的有视力损伤的非增生型DR和不合并玻璃体积血及视网膜牵拉的增生型DR患者,相较于全视网膜激光光凝(PRP),有条件可以考虑先行抗VEGF药物治疗(弱推荐),PRP始终是治疗进行性发展的无灌注区的金标准;光相干断层扫描、广角光相干断层扫描血管成像、广角荧光素眼底血管造影等DR评估设备的飞速发展,对DR病变程度、治疗反应和预后提供了影像学生物学标志。我们相信这一版指南将推动我国DR的诊疗进入新的高度。Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China(2022)is based on evidences in recent clinical trials and a system of Grading of Recommendations,Assessment,Development and Evaluation of evidence quality and strength of recommendations.The main key points around why the diabetic macular edema(DME)changes the classification,what thresholds for initiating anti-vascular endothelial growth factor(VEGF)drug therapy;eyes with center-involved DME(CI-DME)and good vision for clinical significant macular edema still treated by focal laser even with good vision,the clinical pathway for CI-DME changes first-line treatment from laser to anti-VEGF,loading dose of anti-VEGF for CI-DME in non-proliferative diabetic retinopathy(DR)from 3 injections up to 4-5 injections is recommended;severe non-proliferative DR and proliferative DR with vision impairment but without hemorrhages and retinal traction could be considered first treatment of anti-VEGF comparing to initiate pan-retinal photocoagulation(PRP)(weakly recommended),PRP is still gold-standard for progressive non-perfusion area of retina.With the rapid development of DR evaluation devices such as optical coherence tomography,wide-angle optical coherence tomography angiography and wide-angle fluorescein fundus angiography,imaging biomarkers have been provided for the degree of DR lesion,treatment response and prognosis.It is believed that the clinical practice will be promoted a new height by the 2022 edition of Chinese DR guideline.

关 键 词：糖尿病视网膜病变 指南 血管生成抑制剂 激光凝固术 循证医学 述评 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]