(精编)【医学教学课件】Treating Diabetic Cystoid Macular Edema with Intravitreal Triamcinolone Pars Plana Steroid Implant教学课件.pptVIP

Thank You 谢谢大家 The conventional DME treatment is macular laser photocoagulation. In the ETDRS trials, it has been shown to be effective in reducing the risk of visual loss and persistent macular edema. However the long term results are suboptimal and laser treatment is not without complications. The conventional DME treatment is macular laser photocoagulation. In the ETDRS trials, it has been shown to be effective in reducing the risk of visual loss and persistent macular edema. However the long term results are suboptimal and laser treatment is not without complications. So are there any alternative solutions? To answer this question, we must first understand the pathogenesis of DME. Cystoid macular edema can be seen histologically as cysts in the outer plexiform and inner nuclear layers, with leakage from the retinal vasculature and retinal pigment epithelium. It is generally accepted that a breakdown of the inner blood retina barrier is the basis of DME with a possible endogenous permeability factor released by the ischemic retina. Newer theories suggest microglia may play a role. In the normal retina, micrglia is present in the perivascular or parenchymal regions of the inner retinal layers. In diabetic macular edema, there is an increase in the number of microglia… It has been identified recently that there is an increase in chemokines, RANTES and MCP1 in ischaemic diabetic retinopathy. It is possible that this causes an activation of microglai, which in turn produces cytokines, since as TNF alpha and nitrous oxide, which leads to cystoid macular edema. It has been proposed that corticosteroids may act by preventing the activation of microglia, and how does it does it do that? Corticosteroids down regulate the arachidonic acid pathway and prostalglandin produce and it reduces the production of VEGF. In recent years, there has been a surge of interest in the use of corticosteroids for the treatment of CME, including the topical, periocular and intravi