<p>The Evolving Treatment of Diabetic Retinopathy</p>

Abstract

Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

A Humanized Antibody against LRG1 that Inhibits Angiogenesis and Reduces Retinal Vascular Leakage

“…The clinical presentation of nvAMD and diabetic eye disease is characterised by a spectrum of phenotypes, and although the anti-VEGF therapeutics are generally highly effective the heterogeneity of these conditions is accompanied by a variable response to treatment. [22][23][24] Attempts to generate improved therapeutics that capture poor-and non-responders can be broadly divided into two categories, one being the development of alternative and longer-acting anti-VEGFs, while other efforts have focused on alternative targets such as Ang2 and PDGF. 25 It was a search for novel regulators of pathological angiogenesis that led us, through transcriptomic analysis of a number of rodent models of retinal vascular disease, to the discovery of LRG1.…”

PPARα Agonist Oral Therapy in Diabetic Retinopathy

“…Dramatic advances in the diagnosis and treatments of DR have been made [ 14 ]. To date, treatments for DR are laser photocoagulation, topical injection of corticosteroids, intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents, and vitreoretinal surgery [ 15 ]. These treatments are applicable only at the late stages of DR and may cause significant side effects [ 16 , 17 ].…”

Role of vitamin D in diabetic retinopathy: Pathophysiological and clinical aspects

“…Further intensification of treatment to maintain HbA1c below 6% with the modalities available today poses severe risks of hypoglycemia in T2DM patients with increased mortality [67]. In this perspective, local and systemic treatments with biological compounds as well as with the somatostatin analog octreotide [68][69][70] are promising additional tools. In 2000, Aksoy et al found an inverse relationship between presence and severity of DR, and VD concentrations, being the lowest in proliferative DR and the highest in diabetic patients without DR [71].…”