糖尿病视网膜病变是一种慢性进展性疾病。
单用黄斑激光疗法治疗糖尿病黄斑水肿的患者可能出现患眼或对侧眼复发。治疗通常限于视网膜增厚区域,而未治疗的区域可能发生水肿。虽然经过治疗,仍可能出现视力减退。[52]Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. ETDRS report number 2. Ophthalmology. 1987 Jul;94(7):761-74.http://www.ncbi.nlm.nih.gov/pubmed/3658348?tool=bestpractice.com 相比之下,接受雷珠单抗联合延迟或即时激光治疗的累及黄斑中心凹的糖尿病黄斑水肿患者 ,5 年后在视力检查时多可辨认出视力表上的 9.8 或 7.2 个字母。[79]Bressler SB, Glassman AR, Almukhtar T, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema. Am J Ophthalmol. 2016 Apr;164:57-68.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811755/http://www.ncbi.nlm.nih.gov/pubmed/26802783?tool=bestpractice.com
单用全视网膜光凝术治疗增殖性糖尿病视网膜病变 (PDR) 的患者与未接受治疗的患者相比,前者不太可能因玻璃体出血而丧失视力。虽然许多患者经治疗后仍可能出血,但是很多患者会因纤维血管增殖停止而达到一个稳定状态。[47]Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS report number 8. Ophthalmology. 1981 Jul;88(7):583-600.http://www.ncbi.nlm.nih.gov/pubmed/7196564?tool=bestpractice.com鉴于在治疗增殖性糖尿病视网膜病变中,与全视网膜光凝术相比,使用阿柏西普单药治疗很好地提高了视力,该疾病的预后可能在将来得到改善。[64]Sivaprasad S, Prevost AT, Vasconcelos JC, et al. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017 Jun 3;389(10085):2193-203.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31193-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/28494920?tool=bestpractice.com
经过玻璃体切除术的患眼术后通常很少出现视网病变进展。