Treatment strategy for diabetic macular edema based on clinical and basic research

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K11272
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Ophthalmology
• Research Institution: Tokyo Medical University
• Principal Investigator: Shimura Masahiko 東京医科大学, 医学部, 教授 (20302135)
• Co-Investigator(Kenkyū-buntansha): 安田 佳奈子 東京医科大学, 医学部, 講師 (70647461)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 糖尿病黄斑浮腫 / VEGF阻害薬 / 治療プロトコール / サイトカイン

Outline of Final Research Achievements

Although VEGF inhibitors are the first choice for treatment of diabetic macular edema (DME), drug sensitivity is known to differ depending on the case. According to this study, aqueous VEGF, PlGF and inflammatory cytokines involved in type 1 VEGF receptor were found to be elevated in the eyes with good responders. In addition, it was found that the inflammatory cytokine represented by MCP-1 is correlated with the change in edema.
Clinically, using the morphological based loading injections of VEGF inhibitors for DME, it has been found that the administration frequency can be reduced while maintaining the vision prognosis as compared with the conventional administration method. However, there were still poor responded DME eyes which should be solved for be unmet needs.

Free Research Field

網膜硝子体

Academic Significance and Societal Importance of the Research Achievements

現在、糖尿病黄斑浮腫に対する治療の第一選択はVEGF阻害薬治療であるが、1回投与で有効な症例もあれば、何度投与しても反応しない症例もあり、いつまで、どのようにVEGF阻害薬を投与してよいかは施設や担当医の経験で決められていた。本研究成果から、VEGF阻害薬に反応しやすい症例は、炎症や虚血が著明であることが判明し、すなわち急性期の症例であることが分かった。言い換えると糖尿病黄斑浮腫へのVEGF阻害薬治療は出来るだけ早期に行うべきという結果となった。
また、投与方法については浮腫を指標にして、定期的に投与することで不必要な導入期投与を行う必要はないことが証明された。