Retinaerkrankungen bei Diabetes mellitus – Definitionen und Therapieoptionen

Die Retinakomplikationen beim Diabetes mellitus sind die diabetische Retinopathie und die diabetische Makulopathie. Erstere wird in die nicht-proliferative diabetische Retinopathie, bei der das Hauptmerkmal die Regression der Retinagefäße ist, und in die proliferative diabetische Retinopathie mit Gefäßneubildung eingeteilt. Bei der diabetischen Makulopathie kommt es durch Hyperpermeabilität der Gefäße zu einem Ödem im Bereich der Makula. Gefäßneubildung und Hyperpermeabilität werden hauptsächlich durch den vaskulären endothelialen Wachstumsfaktor (VEGF) induziert. VEGF-antagonisierende Wirkstoffe treten deswegen immer mehr in den Vordergrund der Retinakomplikationen des Diabetes mellitus.

Diabetic retina complications are diabetic retinopathy and diabetic macular edema. Diabetic retinopathy includes non-proliferative retinopathy, the hallmark of which is vascular regression and proliferative retinopathy that presents with excessive retinal neovascularization. Vascular hyperpermeability is crucial in diabetic macular edema. Neovascularization and vascular hyperpermeability are induced to a large extent by vascular endothelial growth factor (VEGF). Therefore, VEGF-antagonists play an increasing role in the therapy of diabetic retina complications.

Key words

Diabetic retina complications - retinopathy - macular edema - VEGF-antagonists

• Literatur

• 1 Kempen JH, O'Colmain BJ, Leske MC et al. The prevalence of diabetic retinopathy among adults in the United States. Archives of ophthalmology 2004; 122: 552-563
• 2 Wilkinson CP, Ferris 3rd FL, Klein RE et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110: 1677-1682
• 3 Nationale Versorgungsleitlinie, Typ 2 Diabetes, Prävention und Therapie von Netzhautkomplikationen, Version 2.6.2010.
• 4 ETDRS group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Archives of ophthalmology 1985; 103: 1796-1806
• 5 AAORV Panel. Prefered Practice Pattern Guidelines. Diabetic Retinopathy 2012;
• 6 Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Archives of ophthalmology 1984; 102: 520-526
• 7 Fong DS, Aiello L, Gardner TW et al. Retinopathy in diabetes. Diabetes care 2004; 27 (Suppl. 01) 84-87
• 8 Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Archives of ophthalmology 1984; 102: 527-532
• 9 DCCT Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986
• 10 UKPDS Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853
• 11 van Leiden HA, Dekker JM, Moll AC et al. Blood pressure, lipids, and obesity are associated with retinopathy: the hoorn study. Diabetes care 2002; 25: 1320-1325
• 12 UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703-713
• 13 Chew EY, Ambrosius WT, Davis MD et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 2010; 363: 233-244
• 14 Keech AC, Mitchell P, Summanen PA et al. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet 2007; 370: 1687-1697
• 15 Hammes HP, Feng Y, Pfister F, Brownlee M. Diabetic retinopathy: targeting vasoregression. Diabetes 2011; 60: 9-16
• 16 Hammes HP, Lin J, Wagner P et al. Angiopoietin-2 causes pericyte dropout in the normal retina: evidence for involvement in diabetic retinopathy. Diabetes 2004; 53: 1104-1110
• 17 Giacco F, Brownlee M. Oxidative stress and diabetic complications. Circulation research 2010; 107: 1058-1070
• 18 Adamis AP, Berman AJ. Immunological mechanisms in the pathogenesis of diabetic retinopathy. Seminars in immunopathology 2008; 30: 65-84
• 19 Chavakis T. Interactions of Leukocytes with the Endothelium in the Retina. Hammes HP (Hrsg). Front Diabetes. Karger 2010;
• 20 Kim SY, Johnson MA, McLeod DS et al. Neutrophils are associated with capillary closure in spontaneously diabetic monkey retinas. Diabetes 2005; 54: 1534-1542
• 21 Joussen AM, Murata T, Tsujikawa A et al. Leukocyte-mediated endothelial cell injury and death in the diabetic retina. The American journal of pathology 2001; 158: 147-152
• 22 Miyamoto K, Khosrof S, Bursell SE et al. Prevention of leukostasis and vascular leakage in streptozotocin-induced diabetic retinopathy via intercellular adhesion molecule-1 inhibition. Proceedings of the National Academy of Sciences of the United States of America 1999; 96: 10836-10841
• 23 Joussen AM, Poulaki V, Le ML, Koizumi K et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. FASEB Journal 2004; 18: 1450-1452
• 24 Johnson MW. Etiology and treatment of macular edema. American journal of ophthalmology 2009; 147
• 25 Sapieha P, Hamel D, Shao Z et al. Proliferative retinopathies: angiogenesis that blinds. The international journal of biochemistry & cell biology 2010; 42: 5-12
• 26 Lang GE. Diabetic macular edema. Ophthalmologica 2012; 227 (Suppl. 01) 21-29
• 27 Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report no. 4. The Early Treatment Diabetic Retinopathy Study Research Group. International ophthalmology clinics 1987; 27: 265-272
• 28 Network DRCR. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology 2008; 115: 1-10
• 29 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. Ophthalmology 2010; 117
• 30 Nguyen QD, Brown DM, Marcus DM et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 2012; 119: 789-801
• 31 Mitchell P, Bandello F, Schmidt-Erfurth U et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology 2011; 118: 615-625
• 32 Holash J, Davis S, Papadopoulos N et al. VEGF-Trap: a VEGF blocker with potent antitumor effects. Proceedings of the National Academy of Sciences of the United States of America. 2002; 99: 11393-11398
• 33 Do DV, Nguyen QD, Boyer D, Schmidt-Erfurth U, Brown DM, Vitti R et al. One-year outcomes of the DA VINCI Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology 2012; 119: 1658-1665
• 34 DOG Bu. Leitlinie Nr20 Diabetische Retinopathie. 2011
• 35 Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. The Diabetic Retinopathy Vitrectomy Study Research Group. Archives of ophthalmology 1985; 103: 1644-1652
• 36 Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology 1978; 85: 82-106
• 37 Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991; 98 (Suppl. 05) 766-785
• 38 Ip MS, Domalpally A, Hopkins JJ, Wong P, Ehrlich JS. Long-term effects of ranibizumab on diabetic retinopathy severity and progression. Archives of ophthalmology 2012; 130: 1145-1152