endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2024-5-4-20endofocus-128Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWМеждисциплинарный подход к ведению диабетической ретинопатии: роль офтальмолога и эндокринологаInterdisciplinary approach to the management of diabetic retinopathy: The role of ophthalmologist and endocrinologisthttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна – д.м.н., профессор, зав. кафедрой эндокринологии ИКМ 

Москва

Tatiana Y. Demidova – D. Sci. (Med.), Prof.

Moscow

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-7790-9242ШадричевФ. Е.ShadrichevE. E.

Шадричев Федор Евгеньевич – к.м.н., зав. офтальмологическим отделением, Региональный эндокринологический центр СПб ГБУЗ «ГКДЦ №1», ассистент кафедры офтальмологии ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Минздрава России

Санкт-Петербург

Fedor E. Shadrichev – C. Sci. (Med.), Head of the Ophthalmology Department, Regional Endocrinological Center “City Consultative and Diagnostic Center No. 1”; Associate Professor of the Department of Ophthalmology, Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of the Russian Federation

St. Petersburg

shadrichev_dr@mail.ruhttps://orcid.org/0000-0002-3877-2474ГригорьеваН. Н.GrigorievaN. N.

Григорьева Нюргуяна Николаевна – к.м.н., ассистент кафедры оториноларингологии и офтальмологии, ФГБОУ ВО «Санкт-Петербургский государственный университет», главный врач ООО «Офтакон клиника»

Санкт-Петербург

Nyurguyana N. Grigorieva – C. Sci. (Med.), Associate Professor of the Department of Otorhinolaryngology and Ophthalmology, Saint-Petersburg State University, Head physician “Oftacon Clinic” LLC

St. Petersburg

grinur@mail.ruФишерВ. А.FischerV. A.

Фишер Валентина Андреевна – врач-офтальмолог

Санкт-Петербург

Valentina A. Fisher – ophthalmologist

St. Petersburg

valiamamleeva@mail.ruhttps://orcid.org/0000-0001-5512-6899УшановаФ. О.UshanovaF. O.

Ушанова Фатима Омариевна – к.м.н., доцент кафедры эндокринологии ИКМ 

Москва

Fatima O. Ushanova – C. Sci. (Med.), Associate Professor of the Department of Endocrinology of the Faculty of Medicine

Moscow

fati_2526@mail.ruНадыбинаМ. Н.NadybinaM. N.

Надыбина Маргарита Николаевна – аспирант кафедры эндокринологии ИКМ 

Москва

Margarita N. Nadybina – Clinical resident of the Department of Endocrinology of the Faculty of Medicine

Moscow

mita0098@gmail.comФГАОУ ВО «Российский национальный медицинский университет имени Н.И. Пирогова» Минздрава РоссииPirogov Russian National Research CenterФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Минздрава России; Региональный эндокринологический центр СПб ГБУЗ «Городской консультативно-диагностический центр № 1»Pavlov First Saint Petersburg State Medical University; Regional Endocrinological Center “City Consultative and Diagnostic Center No. 1”ФГБОУ ВО «Санкт-Петербургский государственный университет» ООО «Офтакон клиника»Saint-Petersburg State University; “Oftacon Clinic” LLCРегиональный эндокринологический центр СПб ГБУЗ «Городской консультативно-диагностический центр № 1»Regional Endocrinological Center “City Consultative and Diagnostic Center No. 1”202425122024545665Copyright © Демидова Т.Ю., Шадричев Ф.Е., Григорьева Н.Н., Фишер В.А., Ушанова Ф.О., Надыбина М.Н., 20252025Демидова Т.Ю., Шадричев Ф.Е., Григорьева Н.Н., Фишер В.А., Ушанова Ф.О., Надыбина М.Н.Demidova T.Y., Shadrichev E.E., Grigorieva N.N., Fischer V.A., Ushanova F.O., Nadybina M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/128

Диабетическая ретинопатия (ДР) и диабетический макулярный отек (ДМО) – распространенные хронические осложнения сахарного диабета (СД), борьба с которыми является актуальной проблемой современного здравоохранения. ДР – пятая по распространенности причина слепоты во всем мире и главная причина снижения зрения у пациентов с СД. В эффективном управлении ДР ключевую роль играет междисциплинарный подход, при этом роль эндокринолога заключается в достижении оптимальных показателей гликемического контроля как основного патогенетического фактора и регулярном направлении на скрининг пациентов из групп риска. В свою очередь, перед офтальмологами стоит задача непосредственной диагностики изменений глазного дна и лечения ДР на различных стадиях. Современные представления о механизмах развития ДР и роли VEGF позволяют выделить несколько основных направлений терапии. Так, основным методом лечения ДР служит лазерная коагуляция сетчатки (ЛКС), а наиболее эффективным методом лечения ДМО считается комбинация ЛКС и интравитреального введения ингибиторов ангиогенеза. В настоящее время интравитреальное введение средств, препятствующих новообразованию сосудов, является терапией первой линии при ДМО с вовлечением центра макулы. В данном обзоре представлена информация о патогенезе, современной классификации и актуальных подходах к ведению больных ДР в рамках взаимодействия офтальмолога и эндокринолога.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are common chronic complications of diabetes mellitus, the fight against which is an urgent problem of modern healthcare. DR is the fifth most common cause of blindness worldwide and the main cause of vision loss in patients with diabetes. An interdisciplinary approach plays a key role in the effective management of DR, in which the role of the endocrinologist is to achieve optimal indicators of glycemic control as the main pathogenetic factor, and regular referral to screening of patients from risk groups. In turn, ophthalmologists are faced with the task of directly diagnosing changes in the fundus and treating eye diseases at various stages. Modern ideas about the mechanisms of development of DR and the role of VEGF allow us to identify several main areas of therapy. Thus, the main method of treating DR is laser retinal coagulation (LRC), and the most effective method of treating DME is considered to be a combination of LRC and intravitreal administration of angiogenesis inhibitors. Currently, intravitreal administration of agents that prevent the neoangiogenesis is the first-line treatment for DME involving the center of the macula. This review provides information on the pathogenesis, modern classification and current approaches to the management of patients with DR in the framework of the interaction of an ophthalmologist and an endocrinologist.

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