{"title":"糖尿病视网膜病变源于光感受器的临床证据","authors":"Rithwick Rajagopal MD, PhD , Timothy Kern PhD","doi":"10.1016/j.xops.2024.100591","DOIUrl":null,"url":null,"abstract":"<div><h3>Clinical Relevance</h3><p>Although diabetes is associated with a classic microvascular disease of the retina, it is also increasingly being recognized as a cause of retinal neuropathy. Preclinical evidence suggests that retinal neuropathy in diabetes manifests in part as photoreceptor dysfunction, preceding the development of vascular features in experimental models. It remains unknown whether such findings are relevant to patients with diabetes.</p></div><div><h3>Methods</h3><p>Here, we review 4 lines of clinical evidence suggesting that diabetes-associated photoreceptor pathology is linked to the development of retinal microvascular disease.</p></div><div><h3>Results</h3><p>First, a major population-based investigation of susceptibility loci for diabetic retinopathy (DR) implicated a photoreceptor protein product as a protective factor. Next, electroretinography and other studies of visual function collectively show that rod and/or cone-derived abnormalities occur decades before the development of vascular features of DR. Third, protection from DR seemingly develops in patients with coincident retinitis pigmentosa, as suggested by several case series. Finally, based on anatomic features, we propose that the beneficial effect of macular laser in DR occurs via ablation of diseased photoreceptors.</p></div><div><h3>Conclusions</h3><p>The evidence we present is limited due to the small patient populations used in the studies we cite and due to the lack of methodologies that allow causative relationships to be inferred. Collectively, however, these clinical observations suggest that photoreceptors are involved in early diabetic retinal disease and may in fact give rise to the classic features of DR.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 1","pages":"Article 100591"},"PeriodicalIF":3.2000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001271/pdfft?md5=03b8c3f460842b579f490019dd45ab72&pid=1-s2.0-S2666914524001271-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Clinical Evidence of a Photoreceptor Origin in Diabetic Retinal Disease\",\"authors\":\"Rithwick Rajagopal MD, PhD , Timothy Kern PhD\",\"doi\":\"10.1016/j.xops.2024.100591\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Clinical Relevance</h3><p>Although diabetes is associated with a classic microvascular disease of the retina, it is also increasingly being recognized as a cause of retinal neuropathy. Preclinical evidence suggests that retinal neuropathy in diabetes manifests in part as photoreceptor dysfunction, preceding the development of vascular features in experimental models. It remains unknown whether such findings are relevant to patients with diabetes.</p></div><div><h3>Methods</h3><p>Here, we review 4 lines of clinical evidence suggesting that diabetes-associated photoreceptor pathology is linked to the development of retinal microvascular disease.</p></div><div><h3>Results</h3><p>First, a major population-based investigation of susceptibility loci for diabetic retinopathy (DR) implicated a photoreceptor protein product as a protective factor. Next, electroretinography and other studies of visual function collectively show that rod and/or cone-derived abnormalities occur decades before the development of vascular features of DR. Third, protection from DR seemingly develops in patients with coincident retinitis pigmentosa, as suggested by several case series. Finally, based on anatomic features, we propose that the beneficial effect of macular laser in DR occurs via ablation of diseased photoreceptors.</p></div><div><h3>Conclusions</h3><p>The evidence we present is limited due to the small patient populations used in the studies we cite and due to the lack of methodologies that allow causative relationships to be inferred. Collectively, however, these clinical observations suggest that photoreceptors are involved in early diabetic retinal disease and may in fact give rise to the classic features of DR.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.</p></div>\",\"PeriodicalId\":74363,\"journal\":{\"name\":\"Ophthalmology science\",\"volume\":\"5 1\",\"pages\":\"Article 100591\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2666914524001271/pdfft?md5=03b8c3f460842b579f490019dd45ab72&pid=1-s2.0-S2666914524001271-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ophthalmology science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666914524001271\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmology science","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666914524001271","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
临床意义虽然糖尿病与典型的视网膜微血管病变有关,但人们也越来越认识到糖尿病也是视网膜神经病变的原因之一。临床前证据表明,糖尿病视网膜神经病变部分表现为光感受器功能障碍,比实验模型中血管特征的出现更早。结果首先,一项基于人群的糖尿病视网膜病变(DR)易感性位点调查显示,光感受器蛋白产品是一种保护性因素。其次,视网膜电图和其他视觉功能研究共同表明,视杆细胞和/或视锥细胞的异常在出现 DR 的血管特征之前几十年就已出现。第三,正如几个病例系列所表明的那样,DR 的保护作用似乎发生在同时患有视网膜色素变性的患者身上。最后,根据解剖学特征,我们认为黄斑激光对 DR 的有益作用是通过消融病变的光感受器实现的。结论由于我们引用的研究中使用的患者群体较小,而且缺乏推断因果关系的方法,因此我们提供的证据是有限的。但总的来说,这些临床观察结果表明,光感受器参与了早期糖尿病视网膜病变,并可能在事实上导致了DR的典型特征。
Clinical Evidence of a Photoreceptor Origin in Diabetic Retinal Disease
Clinical Relevance
Although diabetes is associated with a classic microvascular disease of the retina, it is also increasingly being recognized as a cause of retinal neuropathy. Preclinical evidence suggests that retinal neuropathy in diabetes manifests in part as photoreceptor dysfunction, preceding the development of vascular features in experimental models. It remains unknown whether such findings are relevant to patients with diabetes.
Methods
Here, we review 4 lines of clinical evidence suggesting that diabetes-associated photoreceptor pathology is linked to the development of retinal microvascular disease.
Results
First, a major population-based investigation of susceptibility loci for diabetic retinopathy (DR) implicated a photoreceptor protein product as a protective factor. Next, electroretinography and other studies of visual function collectively show that rod and/or cone-derived abnormalities occur decades before the development of vascular features of DR. Third, protection from DR seemingly develops in patients with coincident retinitis pigmentosa, as suggested by several case series. Finally, based on anatomic features, we propose that the beneficial effect of macular laser in DR occurs via ablation of diseased photoreceptors.
Conclusions
The evidence we present is limited due to the small patient populations used in the studies we cite and due to the lack of methodologies that allow causative relationships to be inferred. Collectively, however, these clinical observations suggest that photoreceptors are involved in early diabetic retinal disease and may in fact give rise to the classic features of DR.
Financial Disclosure(s)
Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.