Diyabetik Retinopati
Özet
Diyabetik retinopati (DR), dünya genelinde 20-74 yaş arası çalışan toplumda görme kaybının en sık sebebi olan önemli bir mikrovasküler komplikasyondur. Global olarak diyabetik hastaların yaklaşık %34.6'sını etkileyen bu hastalığın gelişiminde; diyabet süresi, hiperglisemi, hipertansiyon, dislipidemi, puberte ve gebelik gibi hormonal değişimler ile genetik faktörler majör risk faktörleri arasında yer almaktadır. Patogenezinde, hiperglisemiye bağlı gelişen perisit kaybı, kılcal damar tıkanıklıkları, iskemi ve inflamatuar sitokinlerin artışı rol oynar; bu süreç retina hücrelerinden vasküler endotelyal büyüme faktörü (VEGF) salınımını tetikler. Klinik olarak nonproliferatif (NPDR) ve proliferatif (PDR) olarak ikiye ayrılan hastalıkta, görme kaybına yol açan en önemli etkenler diyabetik makula ödemi (DMÖ) ve iskemedir. Tanısında fundus fotoğrafı, altın standart olan floresein anjiyografi (FA), optik koherens tomografi (OKT) ve OKT anjiyografi gibi gelişmiş yöntemler kullanılır. Tedavi basamaklarında ise VEGF inhibitörleri (anti-VEGF), inflamasyonu baskılayan intravitreal steroid implantları, hasarı azaltan modern lazer fotokoagülasyon yöntemleri ve ileri evre komplikasyonlar için pars plana vitrektomi cerrahisi uygulanmaktadır. DR, erken tanı ve multidisipliner bir yaklaşımla kontrol altına alınabilen, ancak tedavi uyumu ve yüksek maliyetler sebebiyle takibi zor olan kronik bir süreçtir.
Diabetic retinopathy (DR) is a major microvascular complication and the leading cause of vision loss among the working-age population (20-74 years) globally. Affecting approximately 34.6% of diabetic patients worldwide, its development is driven by key risk factors including diabetes duration, hyperglycemia, hypertension, dyslipidemia, genetic predisposition, and hormonal shifts during puberty or pregnancy. The pathogenesis involves hyperglycemia-induced pericyte loss, capillary occlusion, ischemia, and elevated inflammatory cytokines, which collectively trigger the release of vascular endothelial growth factor (VEGF). Clinically classified into nonproliferative (NPDR) and proliferative (PDR) stages, the primary causes of vision impairment are diabetic macular edema (DME) and macular ischemia. Diagnosis relies on advanced imaging techniques such as fundus photography, gold-standard fluorescein angiography (FA), optical coherence tomography (OCT), and OCT angiography. Management comprises intravitreal anti-VEGF therapies, long-acting corticosteroid implants to suppress inflammation, modern laser photocoagulation to reduce tissue damage, and pars plana vitrectomy surgery for advanced complications. Ultimately, while DR can be effectively managed through early detection and tailored interventions, patient compliance and high medical costs remain significant challenges in its chronic treatment.
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