Diabetic retinopathy: Early diagnosis and effective treatment

Abstract

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.

Figure 1

Schematic flowchart for the pathogenesis of diabetic retinopathy

Figure 2

Mild non-proliferative diabetic retinopathy with blot hemorrages, mainly on the temporal side of the macula, and clinically significant macular edema with hard exudates

Figure 3

Severe proliferative diabetic retinopathy with neovascularization on the optic disk and vitreous homorrhages

Figure 4

Neovascularization on the iridial surface extending from the edge of the pupil to the chamber angle

Figure 5

Severe proliferative diabetic retinopathy with neovascularization on the optic disk and epiretinal membranes with connective-tissue organization, elevating the retina

Figure 6

Proliferative diabetic retinopathy after panretinal laser coagulation