Diabetic Retinopathy: Understanding Pathologic Angiogenesis and Exploring its Treatment Options

Abstract

Diabetic retinopathy is the major cause of blindness at working age. The pathogenesis behind visual loss is related with retinal angiogenesis and increased retinal vascular permeability. These changes seem to be the result of chronic hyperglycemia and hypoxia. Several mechanisms have been proposed to cause the retinal and vasculature cellular damage. They include the formation of advanced end glycation products, aldose reductase activity and reactive oxygen species. Ultimately, they lead to the expression of VEGF-A. This growth factor seems to play the pivotal role in the development of the complications associated with the disease including break down of the inner blood retinal barrier, macular edema and vasoproliferation. Other mechanisms like inflammation, protein kinase C activity and erythropoietin have been strongly associated with the pathogenesis.Laser therapy is still the standard of care for diabetic retinopathy and prevents severe vision loss in 95% of patients if timely treatment is performed. The better understanding of the disease has led to the production of new management options that may become important adjuvants for the disease. They include intravitreal anti-VEGF therapy, intravitreal steroid therapy and systemic protein kinase C inhibitors. Vitrectomy is an important option for advanced cases of the disease such as tractional retinal detachment or non-absorbing vitreous hemorrhages.

Inflammation and Pharmacological Treatment in Diabetic Retinopathy

“…These side effects also occur with intraocular formulations and may additionally limit their application. Currently, several different steroids are being used to treat DME, namely, triamcinolone, fluocinolone, and dexamethasone [ 49 – 51 ].…”

A Review of Aflibercept Treatment for Macular Disease

“…The physiopathology of diabetic retinopathy (DR) and DMO is complex and still not well understood [ 22 ]. High levels of VEGF-A have been identified in the retina and vitreous of patients with DMO and DR [ 23 ]. This signal protein increases vascular permeability and progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) [ 23 , 24 ].…”

“…High levels of VEGF-A have been identified in the retina and vitreous of patients with DMO and DR [ 23 ]. This signal protein increases vascular permeability and progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) [ 23 , 24 ]. Anti-VEGF drugs can successfully inhibit this protein and prevent the aforementioned consequences.…”

Characteristics of Patient with Proliferative Diabetic Retinopathy Underwent Anti-Vascular Endothelial Growth Factors Injection in Cicendo Eye Hospital, Bandung in January–December 2013

“…11 The examined patients were above 40 years old. A study conducted in the United States of America 12 found that diabetic patients aged above 40 years old have higher prevalence of getting DR which would threaten their eyesight. This study shows that the highest number of patients with DR is dominated by patients aged 50-59 years old while patients above 60 years old are fewer.…”