糖尿病性黄斑水肿长效抗VEGF与激光治疗进展
Advances in Durable Anti-VEGF and Laser Therapy for Diabetic Macular Edema
摘要: 糖尿病性黄斑水肿(diabetic macular edema, DME)是糖尿病性视网膜病变患者视力损害的重要原因，其发生发展涉及血–视网膜屏障破坏、血管通透性增加、缺血缺氧及炎症反应等多重机制，其中血管内皮生长因子(vascular endothelial growth factor, VEGF)是重要治疗靶点。当前DME治疗关注点已由单纯改善视力逐步转向兼顾解剖学控制、给药间隔和长期治疗负担。本文在概述DME发病机制及经典抗VEGF证据的基础上，重点比较阿柏西普8 mg与法瑞西单抗等长效治疗策略，并重新审视传统黄斑激光、阈下微脉冲激光及其与抗VEGF联合应用的临床定位。现有证据表明，黄斑中心受累并伴视力下降者仍应以抗VEGF治疗为基础；长效方案有望减少部分患者的注射与就诊频率，而激光更适合作为非中心受累、持续局灶渗漏或特定联合治疗情境下的补充选择。未来需结合OCT表型、既往治疗反应和患者治疗负担，进一步明确不同方案的获益人群与转换时机。
Abstract: Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetic retinopathy. Its development involves disruption of the blood-retinal barrier, increased vascular permeability, retinal ischemia and hypoxia, and inflammation, with vascular endothelial growth factor (VEGF) representing a major therapeutic target. The focus of DME management has gradually shifted from short-term visual improvement alone toward durable anatomical control, longer treatment intervals, and reduction of long-term treatment burden. This review summarizes the pathogenesis of DME and established anti-VEGF evidence, with particular emphasis on durable strategies such as aflibercept 8 mg and faricimab, and reappraises the current roles of conventional macular laser, subthreshold micropulse laser, and combination therapy. Current evidence supports anti-VEGF therapy as the foundation for center-involved DME with visual impairment, while durable regimens may reduce injection and visit frequency in selected patients. Laser treatment is better positioned as an adjunct for non-center-involved disease, persistent focal leakage, or selected combination strategies. Future management should integrate OCT phenotype, previous treatment response, and individual treatment burden to refine patient selection and switching strategies.
文章引用：赵泽宇, 龙芮怡, 洪晓文, 孟晶. 糖尿病性黄斑水肿长效抗VEGF与激光治疗进展[J]. 临床医学进展, 2026, 16(9): 1550-1559. https://doi.org/10.12677/acm.2026.1693195

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