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Review
. 2017 Dec;24(4):229-241.
doi: 10.1016/j.pathophys.2017.07.001. Epub 2017 Jul 12.

Diabetic retinopathy: Breaking the barrier

Randa S Eshaq  1 , Alaa M Z Aldalati  1 , J Steven Alexander  1 , Norman R Harris  2
Affiliations
Review

Diabetic retinopathy: Breaking the barrier

Randa S Eshaq et al. Pathophysiology. 2017 Dec.

Abstract

Diabetic retinopathy (DR) remains a major complication of diabetes and a leading cause of blindness among adults worldwide. DR is a progressive disease affecting both type I and type II diabetic patients at any stage of the disease, and targets the retinal microvasculature. DR results from multiple biochemical, molecular and pathophysiological changes to the retinal vasculature, which affect both microcirculatory functions and ultimately photoreceptor function. Several neural, endothelial, and support cell (e.g., pericyte) mechanisms are altered in a pathological fashion in the hyperglycemic environment during diabetes that can disturb important cell surface components in the vasculature producing the features of progressive DR pathophysiology. These include loss of the glycocalyx, blood-retinal barrier dysfunction, increased expression of inflammatory cell markers and adhesion of blood leukocytes and platelets. Included in this review is a discussion of modifications that occur at or near the surface of the retinal vascular endothelial cells, and the consequences of these alterations on the integrity of the retina.

Keywords: Blood-retinal barrier; Diabetes; Oxidative stress; Permeability; Retina.

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Figures

Figure 1
Figure 1
Diabetic retinopathy (DR) can be divided into two main stages: non-proliferative DR (NPDR), and proliferative DR (PDR), with NPDR further subdivided into mild NPDR, moderate NPDR, and severe NPDR.
Figure 2
Figure 2
Diabetic retinopathy is marked by microvascular dysfunction, including abnormal neovascularization, hemorrhages, microaneurysms, and cotton wool spots, that will eventually, if not treated, lead to vision loss.
Figure 3
Figure 3
A summary of the factors, not necessarily independent of each other, leading to the development of diabetic retinopathy.
Figure 4
Figure 4
Diabetes-induced retinal microvascular damage, including blood retinal barrier breakdown, can be induced by the factors summarized in this figure.
Figure 5
Figure 5
Normally, as shown in panel A, the retinal endothelium has an intact glycocalyx and tight junctions. However, in diabetic retinopathy, the endothelium has increased permeability and possibly loses a portion of the glycocalyx (Panel B).
See this image and copyright information in PMC

References

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