Pay attention to the whole process management of diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

 Xu Xun , Yang Xiaolu

Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Clinical Key Specialty, Shanghai 200080, China;

Corresponding author：

Xu Xun, Email: drxuxun@sjtu.edu.cn

Keywords：

Diabetic retinopathy; Chronic disease; Disease management; Editorial

DOI：

10.3760/cma.j.cn511434-20230128-00031

Video：

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Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it is a key ocular fundus disease that needs to be paid attention to in the next five years according to the "14th Five-Year" Plan for Eye Health. Promoting the systematic management of DR and constructing the chronic disease management system are the key to the next step of national eye health work. It is necessary to further improve the management mode of the whole course of DR patients with chronic eye disease through the joint action of medical security system at all levels, including strengthening supporting policies of primary medical institutions, optimizing medical service mode and process, strengthening scientific education to improve patients' and doctors' disease cognition, and updating authoritative Chinese DR guidelines to standardize diagnosis and treatment. It is hoped that the low vision and blindness caused by DR in China can be greatly reduced after the implementation of the "14th Five-Year" Plan for Eye Health.

Citation： Xu Xun, Yang Xiaolu. Pay attention to the whole process management of diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2023, 39(2): 95-98. doi: 10.3760/cma.j.cn511434-20230128-00031 Copy

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3.	Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
4.	邓宇轩, 叶雯青, 孙艳婷, 等. 中国糖尿病视网膜病变患病率的荟萃分析[J]. 中华医学杂志, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.Deng YX, Ye WQ, Sun YT, et al. A meta-analysis of prevalence of diabetic retinopathy in China[J]. Natl Med J China, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.
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6.	Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the american diabetes association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
7.	国家卫生健康委. 糖尿病视网膜病变分级诊疗服务技术方案[S]. 2017-04-25.National Health Commission. Hierarchical diagnosis and treatment of diabetic retinopathy[S]. 2017-04-25.
8.	中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group, Ophthalmology Society of Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
9.	中华医学会眼科学会眼底病学组, 中国医师协会眼科医师分会眼底病学组. 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[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Disease Group of Ophthalmology Society of Chinese Medical Association, Fundus disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)[J]. Chin J Ocul Fundus Dis, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.
10.	Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group[J]. Ophthalmology, 1981, 88(7): 583-600. DOI: 10.1016/S0161-6420(81)34978-1.
11.	Pranata R, Vania A. Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: a systematic review and meta-analysis[J]. J Evid Based Med, 2020, 13(2): 116-124. DOI: 10.1111/jebm.12379.
12.	Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials[J]. Br J Ophthalmol, 2018, 102(8): 1077-1085. DOI: 10.1136/bjophthalmol-2017-311344.
13.	Arevalo JF, Lasave AF, Kozak I, et al. Preoperative bevacizumab for tractional retinal detachment in proliferative diabetic retinopathy: a prospective randomized clinical trial[J]. Am J Ophthalmol, 2019, 207: 279-287. DOI: 10.1016/j.ajo.2019.05.007.
14.	El-Batarny AM. Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy[J]. Clin Ophthalmol, 2008, 2(4): 709-716.
15.	Schmidt-Erfurth U, Lang GE, Holz FG, et al. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: The RESTORE extension study[J]. Ophthalmology, 2014, 121(5): 1045-1053. DOI: 10.1016/j.ophtha.2013.11.041.
16.	Brown DM, Schmidt-Erfurth U, Do DV, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the vista and vivid studies[J]. Ophthalmology, 2015, 122(10): 2044-2052. DOI: 10.1016/j.ophtha.2015.06.017.
17.	Liu K, Wang H, He W, et al. Intravitreal conbercept for diabetic macular oedema: 2-year results from a randomised controlled trial and open-label extension study[J]. Br J Ophthalmol, 2022, 106(10): 1436-1443. DOI: 10.1136/bjophthalmol-2020-318690.
18.	Elman MJ, Aiello LP, Beck RW, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema[J]. Ophthalmology, 2010, 117(6): 1064-1077. DOI: 10.1016/j.ophtha.2010.02.031.
19.	Meyer J, Fry C, Turner A, et al. Intravitreal dexamethasone versus bevacizumab in aboriginal and torres strait islander patients with diabetic macular oedema: The OASIS study (a randomised control trial)[J]. Clin Exp Ophthalmol, 2022, 50(5): 522-533. DOI: 10.1111/ceo.14079.
20.	Campochiaro PA, Hafiz G, Mir TA, et al. Pro-permeability factors in diabetic macular edema; the diabetic macular edema treated with ozurdex trial[J]. Am J Ophthalmol, 2016, 168: 13-23. DOI: 10.1016/j.ajo.2016.04.017.
21.	Antonetti DA, Silva PS, Stitt AW. Current understanding of the molecular and cellular pathology of diabetic retinopathy[J]. Nat Rev Endocrinol, 2021, 17(4): 195-206. DOI: 10.1038/s41574-020-00451-4.
22.	Zhao S, Li T, Li J, et al. miR-23b-3p induces the cellular metabolic memory of high glucose in diabetic retinopathy through a SIRT1-dependent signalling pathway[J]. Diabetologia, 2016, 59(3): 644-654. DOI: 10.1007/s00125-015-3832-0.
23.	Chen W, Zhao M, Zhao S, et al. Activation of the TXNIP/NLRP3 inflammasome pathway contributes to inflammation in diabetic retinopathy: a novel inhibitory effect of minocycline[J]. Inflamm Res, 2017, 66(2): 157-166. DOI: 10.1007/s00011-016-1002-6.
24.	Wang N, Zou C, Zhao S, et al. Fenofibrate exerts protective effects in diabetic retinopathy via inhibition of the ANGPTL3 pathway[J]. Invest Ophthalmol Vis Sci, 2018, 59(10): 4210-4217. DOI: 10.1167/iovs.18-24155.
25.	Zheng Z, Chen H, Li J, et al. Sirtuin 1-mediated cellular metabolic memory of high glucose via the LKB1/AMPK/ROS pathway and therapeutic effects of metformin[J]. Diabetes, 2012, 61(1): 217-228. DOI: 10.2337/db11-0416.

1. 国家卫生健康委. “十四五”全国眼健康规划(2021-2025年)[S]. 2022-01-04.National Health Commission. "14th Five-Year" Plan for Eye Health (2021-2025)[S]. 2022-01-04.
2. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J/OL]. Diabetes Res Clin Pract, 2022, 183: 109119[2021-12-06]. https://linkinghub.elsevier.com/retrieve/pii/S0168-8227(21)00478-2. DOI: 10.1016/j.diabres.2021.109119.
3. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
4. 邓宇轩, 叶雯青, 孙艳婷, 等. 中国糖尿病视网膜病变患病率的荟萃分析[J]. 中华医学杂志, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.Deng YX, Ye WQ, Sun YT, et al. A meta-analysis of prevalence of diabetic retinopathy in China[J]. Natl Med J China, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.
5. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华糖尿病杂志, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.Diabetics Branch of Chinese Medical Association. Chinese guidelines for the prevention and treatment of type 2 diabetes (2013 edition)[J]. Chin J Diabetes Mellitus, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.
6. Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the american diabetes association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
7. 国家卫生健康委. 糖尿病视网膜病变分级诊疗服务技术方案[S]. 2017-04-25.National Health Commission. Hierarchical diagnosis and treatment of diabetic retinopathy[S]. 2017-04-25.
8. 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group, Ophthalmology Society of Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
9. 中华医学会眼科学会眼底病学组, 中国医师协会眼科医师分会眼底病学组. 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[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Disease Group of Ophthalmology Society of Chinese Medical Association, Fundus disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)[J]. Chin J Ocul Fundus Dis, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.
10. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group[J]. Ophthalmology, 1981, 88(7): 583-600. DOI: 10.1016/S0161-6420(81)34978-1.
11. Pranata R, Vania A. Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: a systematic review and meta-analysis[J]. J Evid Based Med, 2020, 13(2): 116-124. DOI: 10.1111/jebm.12379.
12. Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials[J]. Br J Ophthalmol, 2018, 102(8): 1077-1085. DOI: 10.1136/bjophthalmol-2017-311344.
13. Arevalo JF, Lasave AF, Kozak I, et al. Preoperative bevacizumab for tractional retinal detachment in proliferative diabetic retinopathy: a prospective randomized clinical trial[J]. Am J Ophthalmol, 2019, 207: 279-287. DOI: 10.1016/j.ajo.2019.05.007.
14. El-Batarny AM. Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy[J]. Clin Ophthalmol, 2008, 2(4): 709-716.
15. Schmidt-Erfurth U, Lang GE, Holz FG, et al. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: The RESTORE extension study[J]. Ophthalmology, 2014, 121(5): 1045-1053. DOI: 10.1016/j.ophtha.2013.11.041.
16. Brown DM, Schmidt-Erfurth U, Do DV, et al. Intravitreal aflibercept for diabetic macular edema: 100-week results from the vista and vivid studies[J]. Ophthalmology, 2015, 122(10): 2044-2052. DOI: 10.1016/j.ophtha.2015.06.017.
17. Liu K, Wang H, He W, et al. Intravitreal conbercept for diabetic macular oedema: 2-year results from a randomised controlled trial and open-label extension study[J]. Br J Ophthalmol, 2022, 106(10): 1436-1443. DOI: 10.1136/bjophthalmol-2020-318690.
18. Elman MJ, Aiello LP, Beck RW, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema[J]. Ophthalmology, 2010, 117(6): 1064-1077. DOI: 10.1016/j.ophtha.2010.02.031.
19. Meyer J, Fry C, Turner A, et al. Intravitreal dexamethasone versus bevacizumab in aboriginal and torres strait islander patients with diabetic macular oedema: The OASIS study (a randomised control trial)[J]. Clin Exp Ophthalmol, 2022, 50(5): 522-533. DOI: 10.1111/ceo.14079.
20. Campochiaro PA, Hafiz G, Mir TA, et al. Pro-permeability factors in diabetic macular edema; the diabetic macular edema treated with ozurdex trial[J]. Am J Ophthalmol, 2016, 168: 13-23. DOI: 10.1016/j.ajo.2016.04.017.
21. Antonetti DA, Silva PS, Stitt AW. Current understanding of the molecular and cellular pathology of diabetic retinopathy[J]. Nat Rev Endocrinol, 2021, 17(4): 195-206. DOI: 10.1038/s41574-020-00451-4.
22. Zhao S, Li T, Li J, et al. miR-23b-3p induces the cellular metabolic memory of high glucose in diabetic retinopathy through a SIRT1-dependent signalling pathway[J]. Diabetologia, 2016, 59(3): 644-654. DOI: 10.1007/s00125-015-3832-0.
23. Chen W, Zhao M, Zhao S, et al. Activation of the TXNIP/NLRP3 inflammasome pathway contributes to inflammation in diabetic retinopathy: a novel inhibitory effect of minocycline[J]. Inflamm Res, 2017, 66(2): 157-166. DOI: 10.1007/s00011-016-1002-6.
24. Wang N, Zou C, Zhao S, et al. Fenofibrate exerts protective effects in diabetic retinopathy via inhibition of the ANGPTL3 pathway[J]. Invest Ophthalmol Vis Sci, 2018, 59(10): 4210-4217. DOI: 10.1167/iovs.18-24155.
25. Zheng Z, Chen H, Li J, et al. Sirtuin 1-mediated cellular metabolic memory of high glucose via the LKB1/AMPK/ROS pathway and therapeutic effects of metformin[J]. Diabetes, 2012, 61(1): 217-228. DOI: 10.2337/db11-0416.

Chinese Journal of Ocular Fundus Diseases

Pay attention to the whole process management of diabetic retinopathy

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