Diabetic macular edema

摘要: A variety of treatment options are available for the diabetic macular edema. They include laser photocoagulation, anti-VEGF drugs, intravitreal steroids, and vitrectomy with or without release vitreoretinal traction. full understanding physiological mechanisms these modalities allows sensible combination options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production thereby decreases leakage plasma proteins from capillaries into tissue. In addition, faster clearance cytokines, such VEGF, retina vitreous cavity. The VEGF-lowering effect can be augmented drugs corticosteroids reduce on capillary permeability. Starling’s law explains vasogenic edema, which is controlled by osmotic hydrostatic gradients between vessel It how VEGF-induced vascular permeability causes protein leak tissue interstitial space, thus decreasing pressure gradient tissue, resulting in water accumulation, i.e. This reversed reducing production, achieved treatment; removing antibodies vitrectomy; steroids. At same time, Starling’s takes account hemodynamic changes that affect gradient. High arterial blood hypoxic vasodilatation increase microcirculation, increases flux induce Treatment hypertension reversal hypoxia reverses this pathophysiology edema. Newton’s third explains, traction retina, stimulates fluxes leading Release mechanism