Abstract
Diabetic retinal disease remains one of the most common complications of diabetes mellitus (DM) and a leading cause of preventable blindness. The mainstay of management involves glycemic control, intravitreal, and laser therapy. However, intravitreal therapy commonly requires frequent hospital visits and some patients fail to achieve a significant improvement in vision. Novel and long-acting therapies targeting a range of pathways are warranted, while evidence to support optimal combinations of treatments is currently insufficient. Improved understanding of the molecular pathways involved in pathogenesis is driving the development of therapeutic agents not only targeting visible microvascular disease and metabolic derangements, but also inflammation and accelerated retinal neurodegeneration. This review summarizes the current and emerging treatments of diabetic retinal diseases and provides an insight into the future of managing this important condition.
Highlights
Diabetic retinal disorders include a spectrum of consequences of glycemic damage in the retina, manifesting in microvascular diabetic retinopathy (DR) leading to neovascularization and retinal detachment, diabetic macular edema (DME), and accelerated underlying neurocellular degeneration [1,2]
The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Trial (UKPDS) for type 1 (T1DM) and type 2 diabetes mellitus (DM) (T2DM) both showed that intensive blood glucose control can delay the onset and progression of DR [6]
Some of the challenges include determining the safety, efficacy, and durability of stem cell therapy, and number and type of cells needed as well as the therapeutic window and target patient population [201]. This review summarized both the well-established pharmacological treatment options as well as recent developments, novel therapeutic agents, and emerging therapies that have the potential to revolutionize the management of DR and DME
Summary
Diabetic retinal disorders include a spectrum of consequences of glycemic damage in the retina, manifesting in microvascular diabetic retinopathy (DR) leading to neovascularization and retinal detachment, diabetic macular edema (DME), and accelerated underlying neurocellular degeneration [1,2]. Anti-VEGF injections are a well-established treatment for Diabetic Macular Edema, a complication of diabetes and a leading cause of blindness in diabetic patients [42] They inhibit VEGF-driven angiogenesis and vascular permeability. Results of the open-label, multicenter, dose-escalation Phase I/II trial evaluated the safety and bioactivity of abicipar pegol It showed a sustained reduction in edema and an improvement in the median BCVA change in some patients. The recent interim results of the PALM study, a Phase II trial, demonstrated that over a period of 28 weeks, 2 mg of intravitreal abicipar pegol every 8 and 12 weeks showed functional and anatomical benefits with fewer intravitreal injections compared with ranibizumab administered every 4 weeks in 151 patients with DME [54]
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