19th EURETINA Congress Keynote Lecture: Diabetic Retinopathy Today

Abstract

In the last decades, significant changes have been taking place regarding the pathogenesis of diabetic retinopathy (DR) and the complex mechanisms that eventually lead to the various manifestations of the disease, including diabetic macular edema (DME). DR was first considered a pure microvascular disease, due to the evident capillary structural changes (microaneurysms), fluid extravasation, and lipid exudation. With the advent of fundus fluorescein angiography, the concept of ischemia and the correlation between peripheral nonperfusion and neovascularization has been introduced, which was eventually followed by the advent of new therapeutic strategies, such as peripheral photocoagulation. Nowadays, thanks to more advanced imaging techniques, namely optical coherence tomography (OCT), OCT angiography, and wide-field imaging (imaging up to 200° of the retina in a single shot), it became clear that other elements participate in the occurrence of DR and DME, including inflamma-tion and neurodegeneration. In the future, integration of standard investigations with new diagnostic devices would allow the prompt recognition of DR even before clinical signs of the disease are ophthalmoscopically evident, and the development of personalized treatment for both retinopathy and DME will be available.

Can the dexamethasone intravitreal implant Ozurdex be safely administered in an out-of-operating room setting?

“…Last but not least, some comments should be made about DME diagnosis. Although DME can be detected by stereoscopic slit-lamp examination using a fundus lens, the importance of optical coherence tomography (OCT) in diagnosing and managing DME needs to be emphasized 42 .…”

“…The question of whether patients who do not adequately respond to anti-VEGF could benefit from an early change to another therapy has not been fully elucidated. Nevertheless, there is new evidence supporting an early switch to DEX in those patients who did not adequately respond to anti-VEGF [12][13][14] .…”

Diabetic Retinopathy In Patients With Type 2 Diabetes: Aspects Of Early Diagnosis, Treatment And Prediction Of The Outcome Of The Disease

“…At the same time, the role of inflammation in DR has been recognized and several anti-inflammatory agents, mainly steroid-based, for intravitreal treatment, are effective. Despite recent scientific advances, strict systemic glycemic control, which is the cornerstone of DR treatment, can reduce the incidence and prevalence of ocular complications, including [32,28].…”

“…At the same time, the risk of developing microangiopathies decreases by 37%, the risk of myocardial infarction -by 14%, stroke -by 12%, heart failure -by 16% [44; 46]. Follow-up of patients in the intensive glycemic control group for ten years after the completion of the study proved the feasibility of achieving optimal glycemic control in patients with type 2 diabetes as early as possible to reduce the risk of myocardial infarction and overall mortality [27,32,33,43].…”

Standardization of Optical Coherence Tomography Angiography Imaging Biomarkers in Diabetic Retinal Disease

“…The use of multimodal imaging approaches, and particularly OCT and OCT-A, facilitates the identification of different pathways of DR and their relative relevance in individual patients [50]. OCT-A has gained a critical position in the evaluation of DR [51] as it allows the identification and quantification of retinal capillary closure, the feature that better correlates with the clinical signs of nonproliferative DR (NPDR) in its main stages and progression [50,52].…”