Pathogenesis and Classification of Proliferative Diabetic Vitreoretinopathy

Abstract

Purpose: To review the current knowledge regarding the pathogenesis of proliferative diabetic vitreoretinopathy (PDVR) and to present recommendations for its clinical staging. Design: Focused literature review and authors’ clinical experience. Results: Although several biochemical mediators may be responsible for the pathogenesis of PDVR, no common biochemical pathway exists. Of those mediators, vascular endothelial growth factor is the one most studied so far. However, since in proliferative diabetic retinopathy (PDR) the thickened posterior vitreous cortex is one of the main factors in the development of proliferations, a consequent shrinkage of the posterior vitreous cortex leads to hemorrhages and tractive retinal detachments. Therefore, PDR should be called PDVR. In consequence, the authors present a new morphological classification of PDVR. Conclusions: There is no consensus about the biochemical pathway responsible for the progression of PDVR. Although several classifications are described in the literature, the classification suggested here is important in the judgment of, the communication about and the therapy of diabetic retinopathy. Furthermore, it is the only reliable classification for predicting the surgical outcome in diabetics.

Increased Uric Acid and Glucose Concentrations in Vitreous and Serum of Patients with Diabetic Macular Oedema

“…The most important determinants for the beginning and progression of DR and diabetic macular oedema are disease duration and the level of metabolic control (glycosylated haemoglobin, HbA 1c , level) [4][5][6][7][8][9] . The manifestation and the progression of DR are modified by multiple systemic factors such as arterial hypertension [1,6,8,10,11] , dyslipidaemia [4,6,8,12] , microalbuminuria [13] , insulin treatment [11] and ocular perfusion pressure [5] .…”

“…The manifestation and the progression of DR are modified by multiple systemic factors such as arterial hypertension [1,6,8,10,11] , dyslipidaemia [4,6,8,12] , microalbuminuria [13] , insulin treatment [11] and ocular perfusion pressure [5] . However, their exact contribution to DR pathogenesis is in most cases unknown.…”

“…Many studies have demonstrated that chronic hyperglycaemia contributes to the pathogenesis of DR [1,5,14] . Hyperglycaemia can alter cellular functions and stimulate the expression of multiple signalling molecules [1,5,15,16] .…”

Prevalência de retinopatia diabética na população portadora de diabetes mellitus tipo 2 do município de Luzerna - SC

“…Para classificar a retinopatia diabética proliferativa (RDP) foi usada a classificação descrita por Kroll et al, que diferencia os estágios da doença baseados em alterações morfológi-cas como segue: Estágio A, Estágio B fase Bn e Bt, Estágio C1-C4 (10)(11) . Foi avaliada a relação da retinopatia diabética com sexo, idade, tempo estimado de diagnóstico, nível de glicemia, nefropatia, hipercolesterolemia, acuidade visual, ní-vel de hemoglobina glicosilada e quanto à presença sistêmica de hipertensão arterial.…”

The Association of Serum Vascular Endothelial Growth Factor and Ferritin in Diabetic Microvascular Disease

“…5 Studies have found that VEGF is involved in the pathogenesis of diabetic complications. [6][7][8] Hyperglycemia-induced diacylglycerol, a lipid molecule, activates protein kinase C in the vascular tissues, and the latter in turn promotes VEGF signaling, resulting in diabetic microvascular complications. 9 Other factors, including hypoxia, gender, smoking, elevated levels of blood lipids, inflammatory status, and activated stress axes, may affect the synthesis and secretion of VEGF; among them, the major physiological stimulus for VEGF expression is the cellular hypoxia.…”