Pathogenesis and Treatment of Diabetic Retinopathy

Abstract

Diabetic retinopathy (DR), one of the most important preventable and / or treatable causes of blindness worldwide, is one of the most important complications of diabetes. Compared to the general population, the risk of blindness is 25 times more. The prevalence of diabetic retinopathy is 77% in patients with type 1 diabetes and 25% in type 2 diabetes. According to the World Health Organization, DR is responsible for 4.8% of all blindness in the world. Although there have been many studies to understand the pathogenesis of diabetic retinopathy, it has not been fully elucidated. However, good blood glucose regulation and control of other systemic factors such as hypertension and hyperlipidemia are very important in stopping the progression of the disease. Despite all the advances in the treatment of diabetic retinopathy, there is no treatment yet that removes retinopathy and leads to sequel-free recovery. Nevertheless, current treatment modalities can prevent legal blindness and allow patients to continue their lives with a level of acceptable vision. It is important to compile up-to-date information, especially in ophthalmology, due to the current advances in the diagnosis and treatment methods of diseases. Therefore, the pathogenesis of diabetic retinopathy and current treatment methods were reviewed in this review.

Keywords

• : argon laser photocoagulation,diabetic retinopathy pathogenesis,diabetic retinopathy treatment,neovascularization,pars plana vitrectomy

DİYABETİK RETİNOPATİ PATOGENEZİ VE TEDAVİSİ

Abstract

Tüm dünyada önlenebilir ve / veya tedavi edilebilir en önemli körlük nedenlerinden biri olan diyabetik retinopati (DR), diabetin en önemli komplikasyonlarından biridir. Genel popülasyona göre körlük riski 25 kat daha fazladır. Diyabetik retinopati prevelansı tip 1 diyabetli hastalarda %77 iken, tip 2 diyabetik hastalarda ise % 25 civarındadır. Dünya Sağlık Örgütü verilerine göre dünya genelindeki tüm körlüklerin %4.8 den DR sorumludur. Diyabetik retinopati patogenezinin anlaşılmasına yönelik yapılan birçok çalışma olmasına rağmen, tam olarak aydınlatılamamıştır. Ancak iyi bir kan şekeri regülasyonu ve HT, hiperlipidemi gibi diğer sistemik faktörlerin kontrolü hastalığın progresyonunu durdurmada çok önemlidir. Diyabetik retinopati tedavisindeki tüm ilerlemelere rağmen henüz retinopatiyi ortadan kaldıran ve sekelsiz iyileşmeyi sağlayan bir tedavi yöntemi yoktur. Yine de, güncel tedavi yöntemleri, yasal körlüğün önüne geçebilmekte ve kabul edilebilir sınırlarda bir görme düzeyi ile hastaların hayatlarını sürdürmelerine olanak sağlamaktadır. Günümüzdeki hastalıkların, özelikle oftalmolojide, tanı ve tedavi yöntemlerindeki hızlı ilerlemeler nedeniyle güncel bilgilerin derlenmesi önem arz etmektedir. Bundan dolayı bu derlemede diyabetik retinopati patogenezi ve güncel tedavi yöntemleri incelenecektir.

Keywords

• : Argon lazer fotokoagülasyon,diyabetik retinopati patogenezi,diyabetik retinopati tedavisi,neovaskülarizasyon,pars plana vitrektomi

References

1. 1. Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Experiment Ophthalmol. 2016; 44: 260-77
2. 2. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Wild S, Roglic G, Greene, Sicree R, King H. Diabetes Care. 2004 May; 27 (5): 1047-53.).
3. 3. Resnikoff S1, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004 Nov; 82 (11): 844-51. Epub 2004 Dec 14.
4. 4. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012; 35: 556-64
5. 5. Roy S1, Kern TS2, Song B3, Stuebe C3.Mechanistic Insights into Pathological Changes in Diabetic Retina: Implications for Targeting Diabetic Retinopathy. Am J Pathol. 2017 Jan; 187 (1): 9-19. Doi: 10.1016 / j.ajpath.2016.08.022. Epub 2016 Nov 12.
6. 6. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs - an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991; 98: 786-806.
7. 7. Jonsson KB1, Frydkjaer-Olseni, Grauslund J. Vascular Changes and Neurodegeneration in Early Stages of Diabetic Retinopathy: Which Comes First? Ophthalmic Res. 2016; 56 (1): 1-9. Doi: 10.1159 / 000444498. Epub 2016 Apr 2.
8. 8. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005; 54: 1615-25.

9. 9. Dasa, McGuire PG, Rangasamy S. Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology. 2015 Jul; 122 (7): 1375-94.
10. 10. Engerman RL. Pathogenesis of diabetic retinopathy. Diabetes 1989; 38: 1203-126.
11. 11. Rand I. Recent advances in diabetic retinopathy. Am J Med. 1981; 70: 595-602.
12. 12. Ciulla TA1, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003 Sep; 26 (9): 2653-64.
13. 13. Gabbay KH. Hyperglicemia, polyol metobolism and complications of diabetes mellitus. Annu. Rev. Med. 1975; 26: 521-536.
14. 14. Cogan DG, Toussaint D, Kuwabara T. Retinal vascular patterns, diabetic retinopathy. Arch Ophthalmol. 1961; 66: 366-378.
15. 15. Friendwald JS. Diabetic retinopathy. Am J Ophthalmol 1950; 33: 1199.
16. 16. Engerman RL. Pathogenesis of diabetic retinopathy. Diabetes 1989; 38: 1203-126.
17. 17. Patz A. Clinical and experimental studies on retinal neovascularization. Am J Ophthalmol 1982; 94: 715-743.
18. 18. Conway MD, Olk RJ. Diabetic maculopathies.Diagnosis and treatment. Ophthalmol Clin North Am. 1993: 213-30.
19. 19. Bresnick GH. Diabetic macular edema, a review. Ophthalmology. 1986; 93: 989-997.
20. 20. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. ETDRS Report No. 1. Arch Ophthalmol 1985; 10: 1796-806.
21. 21. Wu L1, Fernandez-Loaiza P1, Sauma J1, Hernandez-Bogantes E1, Masis M1. Classification of diabetic retinopathy and diabetic macular edema. World J Diabetes. Dec 15, 4 (6): 290-4. Doi: 10.4239 / wjd.v4.i6.290.
22. 22. Harper CA. Treatment of Diabetic Retinopathy. Clin Exp Optom 1999; 82: 98-101
23. 23. Early Treatment Diabetic Retinopathy Study Research Group: Photocoagulation for diabetic macular edema. ETDRS report no.1. Arch Ophthalmol. 1989; 103: 1796806.
24. 24. Trempe CL, Mainster MA, Pomerantzeff O, et al. Macular photocoagulation: Optimal wavelength selection. Ophthalmology. 1982; 721-728.
25. 25. Spalter HF. Photocoagulation of circinate maculopathy in diabetic retinopathy. Am J Ophthalmol. 1971; 71: 242-250.
26. 26. Shimizu K, Koyabashi Y, Muraoka K. Midperipheral fundus involvement in diabetic retinopathy. Ophthalmology. 1981; 88: 601-612.