Diabetic retinopathy: Early diagnosis and effective treatment.

BACKGROUND Diabetic retinopathy is a microangiopathy of the retina from which nearly all persons with diabetes eventually suffer. Two of its complications threaten the patient's vision: diabetic macular edema and proliferative diabetic retinopathy. METHODS Selective literature review, based on national and international guidelines and a literature search from 1981 onward. RESULTS Diabetic retinopathy is subdivided into non-proliferative and proliferative retinopathy. Macular edema can arise at any stage of the disease and threatens visual acuity. The main risk factors for the development and progression of diabetic retinopathy are long duration of diabetes and poor control of blood sugar and arterial blood pressure. Laser photocoagulation is an evidence-based treatment for proliferative retinopathy and macular edema. Vitreous surgery is indicated in cases of worsening vision due to a non-clearing vitreous hemorrhage or tractional retinal detachment. The current options for medical treatment involve the intravitreous injection of glucocorticosteroids or of a VEGF antagonist; both of these options are "off label" at present. CONCLUSION Diabetic retinopathy is the leading cause of blindness among persons of working age in the industrialized world. Regular ophthalmological examinations, timely laser therapy depending on the stage of the disease, and close interdisciplinary cooperation are essential to prevent loss of vision.

[1]  J. McGill,et al.  Similar progression of diabetic retinopathy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: a long-term, randomised, open-label study , 2009, Diabetologia.

[2]  R. Klein,et al.  Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials , 2008, The Lancet.

[3]  Manju Patel,et al.  A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. , 2005, Ophthalmology.

[4]  P. Campochiaro,et al.  Reduction of diabetic macular edema by oral administration of the kinase inhibitor PKC412. , 2004, Investigative ophthalmology & visual science.

[5]  Philip D. Harvey,et al.  Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39 , 1998, BMJ.

[6]  P. Mitchell,et al.  Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial , 2007, The Lancet.

[7]  A. Kampik,et al.  Pars-plana-Vitrektomie bei diabetischer Retinopathie Vom pathogenetischen Prinzip zur operativen Strategie , 2000, Der Ophthalmologe.

[8]  Ukpds,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes , 2002 .

[9]  P. Campochiaro,et al.  An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor Trap-Eye in patients with diabetic macular oedema , 2009, British Journal of Ophthalmology.

[10]  H. Parving,et al.  Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial , 2008, The Lancet.

[11]  J. Jonas.  Intravitreal triamcinolone acetonide for diabetic retinopathy. , 2007, Developments in ophthalmology.

[12]  E. Palacios-Pozo,et al.  PREVENTION OF VISION LOSS AFTER CATARACT SURGERY IN DIABETIC MACULAR EDEMA WITH INTRAVITREAL BEVACIZUMAB: A Pilot Study , 2009, Retina.

[13]  A. Sjølie,et al.  Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes , 1998, The Lancet.

[14]  Helen K. Li,et al.  Effect of ruboxistaurin in patients with diabetic macular edema: thirty-month results of the randomized PKC-DMES clinical trial. , 2007, Archives of ophthalmology.

[15]  Judy E. Kim,et al.  Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. , 2009, Archives of ophthalmology.

[16]  T. Rice,et al.  The early treatment diabetic retinopathy study. , 1982, Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology.

[17]  S. Hörle,et al.  Epidemiologie diabetischer Erblindungen - eine Übersicht , 2002 .

[18]  M. Blum,et al.  [Prevalence of diabetic retinopathy. Check-up program of a public health insurance company in Germany 2002-2004]. , 2007, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.

[19]  U. Müller,et al.  Prävalenz der diabetischen Retinopathie , 2007, Der Ophthalmologe.

[20]  H. Ahmadieh,et al.  Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial--Diabetic Retinopathy Vitrectomy Study Report 4. The Diabetic Retinopathy Vitrectomy Study Research Group. , 1988, Ophthalmology.

[21]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[22]  J. Gerss,et al.  Effect of calcium dobesilate on occurrence of diabetic macular oedema (CALDIRET study): randomised, double-blind, placebo-controlled, multicentre trial , 2009, The Lancet.

[23]  M. Böhm,et al.  Angiotensin blockade to reduce microvascular damage in diabetes mellitus. , 2009, Deutsches Arzteblatt international.

[24]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[25]  J. Szaflik,et al.  Prevention of vision loss after cataract surgery in diabetic macular edema with intravitreal bevacizumab: a pilot study. , 2010, Retina.

[26]  A. Kampik,et al.  [Pars plana vitrectomy in diabetic retinopathy. From pathogenetic principle to surgical strategy]. , 2000, Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft.