pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2024_19_4_S1_74pirogovestnik-200Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESАНТИАНГИОГЕННАЯ ТЕРАПИЯ В ОСЛОЖНЁННЫХ СЛУЧАЯХ ПРОЛИФЕРАТИВНОЙ ДИАБЕТИЧЕСКОЙ РЕТИНОПАТИИANTI-VEGF IN COMPLICATIONS OF PROLIFERATIVE DIABETIC RETHINOPATHYЧехонинЕ. С.ChekhoninE. S.

Москва

Moscow

dr.chekhonin@gmail.comШишкинМ. М.ShishkinM. M.

Москва

Moscow

ПавловскийО. А.PavlovskiiO. A.

Москва

Moscow

ФГБУ Национальный медико-хирургический Центр им. Н.И. ПироговаРоссияPirogov National Medical and Surgical CenterRussian FederationФГБУ Национальный медико-хирургический Центр им. Н.И. Пирогова; Институт усовершенствования врачей, Национальный медико-хирургический Центр им. Н.И. ПироговаРоссияPirogov National Medical and Surgical Center; Institute of Advanced Training of PhysiciansRussian Federation202413112024194приложение 17479Copyright © Чехонин Е.С., Шишкин М.М., Павловский О.А., 20242024Чехонин Е.С., Шишкин М.М., Павловский О.А.Chekhonin E.S., Shishkin M.M., Pavlovskii O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/200

Анализ актуальности использования ингибиторов ангиогенеза (анти-VEGF препаратов) в лечении пролиферативной стадии диабетической ретинопатии. Обзор литературы проведен с использованием поисковых систем PubMed, Сochrane Library, выполнен анализ источников литературы, количеством 30, опубликованных с 2000 по 2024 г. У пациентов с осложненными случаями пролиферативной диабетической ретинопатии предварительное интравитреальное введение ингибиторов ангиогенеза обеспечивает наиболее щадящий подход к хирургическому лечению, что позволяет улучшить анатомические и функциональные результаты витреоретинальной хирургии и способствует уменьшению числа интра- и послеоперационных осложнений.

This paper has the purpose to analyse the relevance of the use of angiogenesis inhibitors (anti-VEGF drugs) in the treatment of the proliferative stage of diabetic retinopathy. The literature review was carried out using the search engines PubMed, the Library, and the analysis of literature sources, 30 in number, published from 2000 to 2024. In patients with complicated cases of proliferative diabetic retinopathy, pre-intravitreal injection of angiogenesis inhibitors provides the most gentle approach to surgical treatment, which improves the anatomical and functional results of vitreoretinal surgery and helps reduce the number of intra- and postoperative complications.

Анти-VEGFдиабетический макулярный отекпролиферативная диабетическая ретинопатияAnti-VEGFdiabetic macular edemaproliferative diabetic rethinopathyReferencesРоль блокады ангиогенеза у пациентов с диабетической ретинопатией / Е. С. Чехонин, Р. Р. Файзрахманов, М. М. Шишкин, М. Р. Каланов // Офтальмохирургия. – 2022. – № 4. – С. 85-91. – DOI 10.25276/0235- 4160-2022-4-85-91. – EDN CUIZPC.Chekhonin E.S., Fayzrakhmanov R.R., Shishkin M.M., Kalanov M.R. Role of inhibition of angiogenesis in patients with diabetic retinopathy. Fyodorov Journal of Ophthalmic Surgery. 2022;4: 85–91. doi: 10.25276/0235-4160-2022-4-85-91 (In Russ.)Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2015; (2): 17. DOI: 10.1186/s40662-015-0026-2.Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2015; (2): 17. DOI: 10.1186/s40662-015-0026-2.Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med 2012; 366 (13): 1227–39. DOI: 10.1056/NEJMra1005073.Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med 2012; 366 (13): 1227–39. DOI: 10.1056/NEJMra1005073.Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO. Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res 2003; 22 (1): 1–29. DOI: 10.1016/s1350–9462(02)00043–5.Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO. Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res 2003; 22 (1): 1–29. DOI: 10.1016/s1350–9462(02)00043–5.Чехонин, Е. С. Анти-VEGF при диабетической ретинопатии: новые перспективы / Е. С. Чехонин // Вестник Национального медико-хирургического центра им. Н.И. Пирогова. – 2022. – Т. 17, № S4. – С. 54-56. – DOI 10.25881/20728255_2022_17_4_S1_54. – EDN IRTPQM.Chekhonin E.S. Anti-VEGF for diabetic retinopathy: new perspectives. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(4,supplement): 54-56. (In Russ.)Анти-VEGF препараты в лечении диабетической ретинопатии / Е. С. Чехонин, Р. Р. Файзрахманов, А. В. Суханова, Э. Д. Босов // Вестник офтальмологии. – 2021. – Т. 137, № 4. – С. 136-142. – DOI 10.17116/oftalma2021137041136. – EDN YJDKIK.Chekhonin ES, Fayzrakhmanov RR, Sukhanova AV, Bosov ED. Anti-VEGF therapy for diabetic retinopathy. Russian Annals of Ophthalmology. 2021;137(4):136 142. (In Russ.)Carmeliet P. Mechanisms of angiogenesis and arteriogenesis. Nat Med 2000; 6 (4): 389–95. DOI: 10.1038/74651.Carmeliet P. Mechanisms of angiogenesis and arteriogenesis. Nat Med 2000; 6 (4): 389–95. DOI: 10.1038/74651.Shibuya M. Differential roles of vascular endothelial growth factor receptor-1 and receptor-2 in angiogenesis. J Biochem Mol Biol 2006; 39 (5): 469–78. DOI: 10.5483/bmbrep.2006.39.5.469.Shibuya M. Differential roles of vascular endothelial growth factor receptor-1 and receptor-2 in angiogenesis. J Biochem Mol Biol 2006; 39 (5): 469–78. DOI: 10.5483/bmbrep.2006.39.5.469.Современное представление о неоваскулярной глаукоме (обзор) / Р. Р. Файзрахманов, М. Е. Калинин, О. А. Павловский [и др.] // Офтальмологические ведомости. – 2023. – Т. 16, № 3. – С. 99-108. – DOI 10.17816/OV490823. – EDN EOIVPW.Fayzrakhmanov R.R., Kalinin M.E., Pavlovsky O.A., Chekhonin E.S., Sekhina O.L. Modern concept of neovascular glaucoma (review) // Ophthalmology Reports. – 2023. – Vol. 16. – N. 3. – P. 99-108. (In Russ.)Ishida S, Usui T, Yamashiro K, et al. VEGF164 is proinflammatory in the diabetic retina. Invest Ophthalmol Vis Sci 2003; 44 (5): 2155–62. DOI: 10.1167/iovs.02–0807.Ishida S, Usui T, Yamashiro K, et al. VEGF164 is proinflammatory in the diabetic retina. Invest Ophthalmol Vis Sci 2003; 44 (5): 2155–62. DOI: 10.1167/iovs.02–0807.Lim JI, Spee C, Hinton DR. A comparison of hypoxia-inducible factor-α in surgically excised neovascular membranes of patients with diabetes compared with idiopathic epiretinal membranes in nondiabetic patients. Retina 2010; 30 (9): 1472–8. DOI: 10.1097/IAE.0b013e3181d6df09.Lim JI, Spee C, Hinton DR. A comparison of hypoxia-inducible factor-α in surgically excised neovascular membranes of patients with diabetes compared with idiopathic epiretinal membranes in nondiabetic patients. Retina 2010; 30 (9): 1472–8. DOI: 10.1097/IAE.0b013e3181d6df09.Abu El-Asrar AM, Missotten L, Geboes K. Expression of hypoxia-inducible factor-1alpha and the protein products of its target genes in diabetic fibrovascular epiretinal membranes. Br J Ophthalmol 2007; 91 (6): 822–6. DOI: 10.1136/bjo.2006.109876.Abu El-Asrar AM, Missotten L, Geboes K. Expression of hypoxia-inducible factor-1alpha and the protein products of its target genes in diabetic fibrovascular epiretinal membranes. Br J Ophthalmol 2007; 91 (6): 822–6. DOI: 10.1136/bjo.2006.109876.Wang X, Wang G, Wang Y. Intravitreous vascular endothelial growth factor and hypoxia-inducible factor 1a in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2009; 148 (6): 883–9. DOI: 10.1016/j.ajo.2009.07.007.Wang X, Wang G, Wang Y. Intravitreous vascular endothelial growth factor and hypoxia-inducible factor 1a in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2009; 148 (6): 883–9. DOI: 10.1016/j.ajo.2009.07.007.Изменение толщины центральной зоны сетчатки после витрэктомии по поводу регматогенной отслойки сетчатки с использованием силиконовой тампонады / Р. Р. Файзрахманов, А. В. Суханова, О. А. Павловский [и др.] // Вестник Национального медико-хирургического центра им. Н.И. Пирогова. – 2020. – Т. 15, № 2. – С. 89-91. – DOI 10.25881/BPNMSC.2020.32.27.015. – EDN IVIYJZ.The change in the thickness of the central zone of the retina after vitrectomy due to rhegmatogenous detachment of the retina using silicone tamponade / R. R. Faizrakhmanov, A. V. Sukhanova, O. A. Pavlovskii [i dr.] // Vestnik Natsional’nogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova. – 2020. – T. 15, № 2. – S. 89-91. – DOI 10.25881/BPNMSC.2020.32.27.015. – EDN IVIYJZ. (In Russ.)Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 2006; 113 (10): 1695. e1–15. DOI: 10.1016/j.ophtha.2006.05.064.Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 2006; 113 (10): 1695. e1–15. DOI: 10.1016/j.ophtha.2006.05.064.Brucker AJ, Qin H, Antoszyk AN, et al. Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol 2009; 127 (2): 132–40. DOI: 10.1001/archophthalmol.2008.565.Brucker AJ, Qin H, Antoszyk AN, et al. Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol 2009; 127 (2): 132–40. DOI: 10.1001/archophthalmol. 2008.565.Googe J, Brucker AJ, Bressler NM, et al. Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal / grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation. Retina 2011; 31 (6): 1009–27. DOI: 10.1097/IAE.0b013e318217d739.Googe J, Brucker AJ, Bressler NM, et al. Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal / grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation. Retina 2011; 31 (6): 1009–27. DOI: 10.1097/IAE.0b013e318217d739.Gross JG, Glassman AR, Jampol LM, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA 2015; 314 (20): 2137–46. DOI: 10.1001/jama.2015.15217.Gross JG, Glassman AR, Jampol LM, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA 2015; 314 (20): 2137–46. DOI: 10.1001/jama.2015.15217.Bressler SB, Beaulieu WT, Glassman AR, et al. Factors associated with worsening proliferative diabetic retinopathy in eyes treated with panretinal photocoagulation or ranibizumab. Ophthalmology 2017; 124 (4): 431–9. DOI: 10.1016/j.ophtha.2016.12.005.Bressler SB, Beaulieu WT, Glassman AR, et al. Factors associated with worsening proliferative diabetic retinopathy in eyes treated with panretinal photocoagulation or ranibizumab. Ophthalmology 2017; 124 (4): 431–9. DOI: 10.1016/j.ophtha.2016.12.005.Gross JG, Glassman AR, Liu D, et al. Five-year outcomes of panretinal photocoagulation vs. intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA Ophthalmol 2018; (136): 1138–48. DOI: 10.1001/jamaophthalmol.2018.3255.Gross JG, Glassman AR, Liu D, et al. Five-year outcomes of panretinal photocoagulation vs. intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA Ophthalmol 2018; (136): 1138–48. DOI: 10.1001/jamaophthalmol.2018.3255.Sivaprasad S, Prevost AT, Vasconcelos JC, et al. CLARITY Study Group. 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 Lond Engl 2017; 389 (10085): 2193–2203. DOI: 10.1016/S0140–6736(17)31193–5.Sivaprasad S, Prevost AT, Vasconcelos JC, et al. CLARITY Study Group. 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 Lond Engl 2017; 389 (10085): 2193–2203. DOI: 10.1016/S0140–6736(17)31193–5.Arevalo JF, Lasave AF, Wu L, et al. Intravitreal bevacizumab for proliferative diabetic retinopathy: results from the Pan-American Collaborative Retina Study group (PACORES) at 24 months of follow-up. Retina 2017; 37 (2): 334–43. DOI: 10.1097/IAE.0000000000001181.Arevalo JF, Lasave AF, Wu L, et al. Intravitreal bevacizumab for proliferative diabetic retinopathy: results from the Pan-American Collaborative Retina Study group (PACORES) at 24 months of follow-up. Retina 2017; 37 (2): 334–43. DOI: 10.1097/IAE.0000000000001181.Lang GE, Stahl A, Voegeler J, et al. Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy – the PRIDE study. Acta Ophthalmol. DOI: 10.1111/aos.14312.Lang GE, Stahl A, Voegeler J, et al. Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy – the PRIDE study. Acta Ophthalmol. DOI: 10.1111/aos.14312.Arevalo JF, Maia M, Flynn HW Jr, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol 2008; 92 (2): 213–6. DOI: 10.1136/bjo.2007.127142.Arevalo JF, Maia M, Flynn HW Jr, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol 2008; 92 (2): 213–6. DOI: 10.1136/bjo.2007.127142.Figueira J, Fletcher E, Massin P, et al. Ranibizumab Plus Panretinal Photocoagulation versus Panretinal Photocoagulation Alone for High-Risk Proliferative Diabetic Retinopathy (PROTEUS Study). Ophthalmology 2018; 125 (5): 691–700. DOI: 10.1016/j.ophtha.2017.12.008.Figueira J, Fletcher E, Massin P, et al. Ranibizumab Plus Panretinal Photocoagulation versus Panretinal Photocoagulation Alone for High-Risk Proliferative Diabetic Retinopathy (PROTEUS Study). Ophthalmology 2018; 125 (5): 691–700. DOI: 10.1016/j.ophtha.2017.12.008.Chatziralli I, Dimitriou E, Theodossiadis G, et al. Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study. Acta Diabetol 2020; 57 (10): 1219–25. DOI: 10.1007/s00592-020-01548-y.Chatziralli I, Dimitriou E, Theodossiadis G, et al. Intravitreal ranibizumab alone or in combination with panretinal photocoagulation for the treatment of proliferative diabetic retinopathy with coexistent macular edema: long-term outcomes of a prospective study. Acta Diabetol 2020; 57 (10): 1219–25. DOI: 10.1007/s00592-020-01548-y.Abdhish RB, Karisse T, Roy WB, et al. Randomized clinical trial evaluating intravitreal ranibizumab or saline for vitreous hemorrhage from proliferative diabetic retinopathy. JAMA Ophthalmol 2013; 131 (3): 283–93. DOI: 10.1001/jamaophthalmol.2013.2015.Abdhish RB, Karisse T, Roy WB, et al. Randomized clinical trial evaluating intravitreal ranibizumab or saline for vitreous hemorrhage from proliferative diabetic retinopathy. JAMA Ophthalmol 2013; 131 (3): 283–93. DOI: 10.1001/jamaophthalmol.2013.2015.Smith JM, Steel DH. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2015; 2015 (8): CD008214. DOI:10.1002/14651858.CD008214.pub3.Smith JM, Steel DH. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2015; 2015 (8): CD008214. DOI:10.1002/14651858.CD008214.pub3.Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: A meta-analysis of randomised controlled trials. Br J Ophthalmol 2018; 102 (8): 1077–85. DOI: 10.1136/bjophthalmol-2017-311344.Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: A meta-analysis of randomised controlled trials. Br J Ophthalmol 2018; 102 (8): 1077–85. DOI: 10.1136/bjophthalmol-2017-311344.Wang DY, Zhao XY, Zhang WF, et al. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: A network meta-analysis. Sci Rep 2020; 10 (1): 18880. DOI: 10.1038/s41598-020-75896-8.Wang DY, Zhao XY, Zhang WF, et al. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: A network meta-analysis. Sci Rep 2020; 10 (1): 18880. DOI: 10.1038/s41598-020-75896-8.Vidinova CN, Gouguchkova PT, Dimitrov T, et al. [Comparative clinical and ultrastructural analysis of the results from ranibizumab and aflibercept in patients with PDR]. Klin Monbl Augenheilkd 2020; 237 (1): 79–84. [in German]. DOI: 10.1055/a-0767-6951.Vidinova CN, Gouguchkova PT, Dimitrov T, et al. [Comparative clinical and ultrastructural analysis of the results from ranibizumab and aflibercept in patients with PDR]. Klin Monbl Augenheilkd 2020; 237 (1): 79–84. [in German]. DOI: 10.1055/a-0767-6951.

The authors declare that there are no conflicts of interest present.