Ophthalmology ReportsOphthalmology ReportsОфтальмологические ведомости1998-71022412-5423Eco-Vector62480010.17816/OV624800IFNEKSReviewsНаучные обзорыReview ArticleDiabetic macular edema and vitreoretinal surgery: a reviewДиабетический макулярный отёк и витреоретинальная хирургия: обзорhttps://orcid.org/0000-0002-4341-35721620-0083FayzrakhmanovRinat R.ФайзрахмановРинат Рустамович
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

rinatrf@gmail.comhttps://orcid.org/0000-0003-3470-62826781-1504PavlovskiyOleg A.ПавловскийОлег Александрович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

olegpavlovskiy@yandex.ruhttps://orcid.org/0009-0007-6353-65498355-9604MartynovAndrei O.МартыновАндрей Олегович
Russian Federation
andrey_099098@mail.ruhttps://orcid.org/0009-0003-9015-71583804-9805LukinykhMichael A.ЛукиныхМихаил Алексеевич
Russian Federation
97mikol97@gmail.comhttps://orcid.org/0000-0003-2234-09145881-8822VaganovaElena E.ВагановаЕлена Евгеньевна
Russian Federation
vaganova.e.e@gmail.comhttps://orcid.org/0000-0002-0353-90744855-2730BogdanovaVioletta A.БогдановаВиолетта Анатольевна
Russian Federation
violbogdanova@gmail.comNational Medical and Surgical Center named after N.I. PirogovНациональный медико-хирургический центр им. Н.И. ПироговаOphthalmological Center "Vision"Офтальмологический центр «Визион»Eye Clinic "Bio Absolut"Глазная клиника «Био Абсолют»3107202619275822012202330042025Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-ВекторCopyright ©; 2026,2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://journals.eco-vector.com/ov/article/view/624800

Diabetic retinopathy, including its complication diabetic macular edema, is considered a socially significant disease of our time. The pathogenesis of these conditions is complex and remains the subject of investigation. There are two forms of diabetic macular edema — intracellular and extracellular. Diabetic intracellular edema develops as a result of intracellular accumulation of sorbitol, lactate, and phosphates, caused by metabolic disturbances in hyperglycemia. Extracellular edema is associated primarily with damage to the blood–retinal barrier, which is accompanied by increased fluid inflow into the tissue and decreased clearance as diabetes progresses. The loss of the protective function of the inner blood–retinal barrier occurs mainly due to damage to the cells and intercellular junctions comprising it. The outer blood–retinal barrier is affected by damage to the external limiting membrane. Currently, the gold standard for the treatment of diabetic macular edema is the use of angiogenesis inhibitors. At the same time, with the development of vitreoretinal surgery, the effect of this method on diabetic macular edema is being actively studied. In addition, new vitreoretinal surgical techniques are being proposed to correct it. However, the results of surgical treatment vary according to different authors. The preservation of the ellipsoid zone and the external limiting membrane are considered as predictors of its effectiveness.

Диабетическую ретинопатию, включая её осложнение — диабетический макулярный отёк, относят к социально значимым заболеваниям нашего времени. Патогенез этих состояний сложен и до настоящего времени остаётся предметом изучения. Различают внутриклеточный и внеклеточный диабетический макулярный отёк. Так, внутриклеточный отёк развивается вследствие накопления в клетках сорбита, лактата и фосфатов, обусловленного метаболическими нарушениями при гипергликемии. Внеклеточный отёк ассоциирован преимущественно с повреждением гематоретинального барьера, что сопровождается повышенным поступлением жидкости в ткань и снижением её клиренса по мере прогрессирования сахарного диабета. Утрата защитной функции внутреннего гематоретинального барьера происходит в основном за счёт повреждения входящих в его состав клеток и межклеточных соединений. На функционирование наружного гематоретинального барьера влияет повреждение наружной пограничной мембраны. В настоящее время «золотым стандартом» терапии диабетического макулярного отёка является применение ингибиторов ангиогенеза. Вместе с тем с развитием витреоретинальной хирургии активно изучают влияния данного метода на течение диабетического макулярного отёка. Кроме того, предлагают новые техники витреоретинальной хирургии, направленные на его коррекцию. Тем не менее, по данным различных авторов, результаты хирургического лечения варьируют. В качестве предикторов его эффективности рассматривают сохранность эллипсоидной зоны и наружной пограничной мембраны.

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