J Korean Med Assoc.  2014 Jun;57(6):525-534. 10.5124/jkma.2014.57.6.525.

Prevention and management of diabetic retinopathy

• Song JH

• KMID: 1958091
• DOI: http://doi.org/10.5124/jkma.2014.57.6.525

Abstract

Diabetic retinopathy(DR) is the leading cause of new onset blindness among working-aged groups in industrialized countries, and its incidence is expected to increase along with the rising incidence of diabetes mellitus. Primary interventions such as strict glycemic control, tight blood pressure regulation, and lipid-lowering therapy can significantly reduce the risk of DR occurrence and progression. Currently, laser photocoagulation is the mainstay of treatment of proliferative DR and some cases of diabetic macular edema (DME). However, a considerable number of DR patients still suffer from severe visual impairment in spite of the application of laser photocoagulation and even of pars plana vitrectomy. Considering the limitations of current DR treatments, ongoing efforts have been devoted to the development of new therapeutic strategies, and it has become necessary to focus on pharmacologic treatment. Since inflammation has been identified as playing a substantial role in the pathogenesis of DR, corticosteroids with an anti-inflammatory effect can be included in the treatment of DR, though this may cause cataract and intraocular pressure elevation. The recent discovery of inhibitors of vascular endothelial growth factor is a revolutionary event in the management of DR, specifically DME. Some new agents aiming at the process of angiogenesis and increased vascular permeability are still under investigation, offering hope for a more effective future treatment of this sight-threatening disease. This paper reviews the current state of knowledge of the clinical presentation, preventive management, and clinical therapeutic strategies of DR and DME.

Keyword

Diabetic retinopathy; Laser coagulation; Corticosteroids; Vascular endothelial growth factors

MeSH Terms

Adrenal Cortex Hormones
Blindness
Blood Pressure
Capillary Permeability
Cataract
Developed Countries
Diabetes Mellitus
Diabetic Retinopathy*
Hope
Humans
Incidence
Inflammation
Intraocular Pressure
Laser Coagulation
Light Coagulation
Macular Edema
Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factors
Vision Disorders
Vitrectomy
Adrenal Cortex Hormones
Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factors

Figure

• 

  Figure 1 (A) Fluorescein angiography of the left eye demonstrates proliferative diabetic retinopathy stage with new vessels at disc (NVD, arrow) and strong vascular leakage. (B) After panretinal photocoagulation, regression of NVD is noted and vascular leakage is decreased with multiple laser scars (arrowheads).

• 

  Figure 2 (A) Optical coherence tomography (OCT) at initial presentation shows severe cystoid macular edema in the right eye of a diabetic patient. (B) At 1 month after 3 monthly intravitreal injections of bevacizumab, OCT reveals much improved macular edema with absorbed cystic pockets.

• 

  Figure 3 (A) Fundus photograph (FP) of the right eye shows fibrovascular membrane associated with traction retinal detachment. (B) Optical coherence tomography (OCT) clearly demonstrates traction membrane and retinal detachment over macular area. (C) Three dimensional (3D) OCT also reveals fibrovascular membrane and associated traction retinal detachment. (D) After pars plana vitrectomy, FP shows flattened retina with removal of fibrovascular membrane. (E) OCT shows restoration of normal contour of fovea with mild macular edema. (F) 3D OCT also confirms removal of fibrovascular membrane and attached retina.

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