Update on Diagnosis and Treatment of Diabetic Retinopathy: A Consensus Guideline of the Working Group of Ocular Health (Spanish Society of Diabetes and Spanish Vitreous and Retina Society).

Borja Corcóstegui,José María Ruiz-Moreno,Santiago Durán,Rafael Simó,Patricia Udaondo,María Olga González-Albarrán,Cristina Hernández,Javier Salvador

doi:10.1155/2017/8234186

Abstract

A group of members of the Spanish Retina and Vitreous Society (SERV) and of the Working Group of Ocular Health of the Spanish Society of Diabetes (SED) updated knowledge regarding the diagnosis and treatment of diabetic retinopathy (DR) based on recent evidence reported in the literature. A synthesis of this consensus forms the basis of the present review, which is intended to inform clinicians on current advances in the field of DR and their clinical applicability to patients with this disease. Aspects presented in this article include screening procedures of DR, new technologies in the early diagnosis of DR, control of risk factors in the different stages of the disease, indications of panretinal laser photocoagulation, efficacy of intravitreal antiangiogenic agents and steroids, and surgical options for treating DR-related complications. Practical information regarding periodicity of screening procedures in patients with type 1 and type 2 diabetes, ophthalmological controls according to the stage of retinopathy and complications, and criteria and degree of urgency for referral of a DR patient to the ophthalmologist are also presented.

Highlights

According to the International Federation of Diabetes (IFD), there will be 642 million people with diabetes in the world in 2040, with a foreseeable dramatic burden of the disease, worrisome in the most extreme population segments, that is, the young people and the elderly subjects [1].These alarming data have an even greater impact on the possible effects of the numerous complications resulting from diabetes
It is important to explain to the patient the following points: (a) panretinal photocoagulation can stop the progression of Proliferative diabetes retinopathy (PDR), but not in all cases; (b) the risk of bleeding persists after treatment because the regression of neovascularization is slow; and (c) panretinal photocoagulation may produce a moderate decrease in vision, visual field or dark-adapted threshold, but the benefit far outweighs the side effects
The Diabetic Retinopathy Clinical Research Network (DRCR.net) recently published the two-year results of Protocol S, which was designed as a noninferiority study to compare panretinal photocoagulation (PRP) and intravitreal ranibizumab (Lucentis, Genentech) for patients with highrisk PDR

Summary

Introduction

According to the International Federation of Diabetes (IFD), there will be 642 million people with diabetes in the world in 2040, with a foreseeable dramatic burden of the disease, worrisome in the most extreme population segments, that is, the young people and the elderly subjects [1]. Formation and fluid extravasation from the intravascular to the interstitial space can lead to retinal thickening and hard exudates [8] This first stage is called nonproliferative diabetic retinopathy (NPDR), or the so-called background DR (Figure 1). Hypoxia promotes vessel growth by upregulating multiple proangiogenic pathways, the vascular endothelial growth factor (VEGF), which plays a pivotal role in the development of pathologic angiogenesis [10]. This stage known as proliferative retinopathy (PDR) is characterized by growth of new vessels (Figure 3). OCT has revolutionized the diagnoses and monitoring of DME, facilitating its management (see Section 2.3)

Prevention of DR

Treatment of DR

Current Treatment of DME

Findings

Concluding Remarks