Pathophysiology of Diabetic Retinopathy: The Old and the New
Open Access
- 1 October 2018
- journal article
- review article
- Published by Korean Diabetes Association in Diabetes & Metabolism Journal
- Vol. 42 (5), 364-376
- https://doi.org/10.4093/dmj.2018.0182
Abstract
Vision loss in diabetic retinopathy (DR) is ascribed primarily to retinal vascular abnormalities-including hyperpermeability, hypoperfusion, and neoangiogenesis-that eventually lead to anatomical and functional alterations in retinal neurons and glial cells. Recent advances in retinal imaging systems using optical coherence tomography technologies and pharmacological treatments using anti-vascular endothelial growth factor drugs and corticosteroids have revolutionized the clinical management of DR. However, the cellular and molecular mechanisms underlying the pathophysiology of DR are not fully determined, largely because hyperglycemic animal models only reproduce limited aspects of subclinical and early DR. Conversely, non-diabetic mouse models that represent the hallmark vascular disorders in DR, such as pericyte deficiency and retinal ischemia, have provided clues toward an understanding of the sequential events that are responsible for vision-impairing conditions. In this review, we summarize the clinical manifestations and treatment modalities of DR, discuss current and emerging concepts with regard to the pathophysiology of DR, and introduce perspectives on the development of new drugs, emphasizing the breakdown of the blood-retina barrier and retinal neovascularization.Keywords
Funding Information
- Japan Society for the Promotion of Science (16H05155)
- Japan Science and Technology Agency
- Takeda Science Foundation
This publication has 99 references indexed in Scilit:
- Targeted deletion of Vegfa in adult mice induces vision lossJCI Insight, 2012
- Signal Transduction by Vascular Endothelial Growth Factor ReceptorsCold Spring Harbor Perspectives in Medicine, 2012
- Semaphorin 3E–Plexin-D1 signaling regulates VEGF function in developmental angiogenesis via a feedback mechanismGenes & Development, 2011
- Oxidative Stress and Diabetic ComplicationsCirculation Research, 2010
- Diabetic retinopathyThe Lancet, 2010
- Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular TractionOphthalmology, 2010
- An essential role for RPE-derived soluble VEGF in the maintenance of the choriocapillarisProceedings of the National Academy of Sciences of the United States of America, 2009
- Selective Loss of Inner Retinal Layer Thickness in Type 1 Diabetic Patients with Minimal Diabetic RetinopathyInvestigative Ophthalmology & Visual Science, 2009
- Transient high glucose causes persistent epigenetic changes and altered gene expression during subsequent normoglycemiaThe Journal of Experimental Medicine, 2008
- A multifocal electroretinogram model predicting the development of diabetic retinopathyProgress in Retinal and Eye Research, 2006