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Beuran DI, Macovei ML, Cornăcel C, Boca IR. Sterile endophthalmitis after intravitreal injection of triamcinolone acetonide: case report and literature review. Rom J Ophthalmol 2024; 68:2-7. [PMID: 38617715 PMCID: PMC11007564 DOI: 10.22336/rjo.2024.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 04/16/2024] Open
Abstract
Objectives: The first purpose is to present the diagnosis and therapeutic approach in a patient with sterile endophthalmitis associated with triamcinolone acetonide injection. The secondary objective is to assess the incidence of this complication and to summarize the risk factors described in the literature. Case presentation: A 76-year-old male patient presented for painless, unilateral, decreased visual acuity, four days after cataract surgery and simultaneously intravitreal triamcinolone acetonide injection for diabetic macular edema in the right eye. The diagnosis of sterile endophthalmitis was made. Eight days after the presentation, the symptoms subsided, the maximum corrected visual acuity reaching that before the procedures. Discussions: The incidence of sterile endophthalmitis varies in the literature between 0% and 23.8%. Visual prognosis is good, although the pathogenesis is not fully understood. Preservatives in injectable solutions have been suggested, however, there are studies in which inflammation was also present with preservative-free products. The particle size of triamcinolone was analyzed, demonstrating an association between smaller particles and an increased frequency of adverse reactions of this type. History of uveitis, posterior capsule rupture following cataract surgery, and Irvine-Gass syndrome are other associations described. Conclusion: The physiopathological mechanism of sterile endophthalmitis is not fully understood. However, the visual prognosis is good, the final vision being dependent on the underlying pathology.
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Affiliation(s)
- David-Ionuț Beuran
- Department of Ophthalmology, „Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
| | - Mioara-Laura Macovei
- Department of Ophthalmology, „Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
- „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Cătălin Cornăcel
- Department of Ophthalmology, „Dr. Carol Davila” Central Military University Emergency Hospital, Bucharest, Romania
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Petrović N, Todorović D, Srećković S, Jovanović S, Petrović M, Stojadinović I, Šarenac Vulović T. IS A DECREASED NITRIC OXIDE CONCENTRATION AFTER TRIAMCINOLONE ACETONIDE INTRAVITREAL INJECTION ONE OF THE REASONS FOR INTRAOCULAR PRESSURE RISE? Acta Clin Croat 2022; 61:620-628. [PMID: 37868182 PMCID: PMC10588379 DOI: 10.20471/acc.2022.61.04.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/14/2021] [Indexed: 10/24/2023] Open
Abstract
Diabetic macular edema is the most common cause of vision loss in patients affected by diabetes mellitus. For eyes with persistent retinal thickening despite anti-VEGF therapy, treatment with intravitreal triamcinolone may be considered, especially in pseudophakic eyes. The aim of this study was to examine aqueous humor nitric oxide concentration changes in pseudophakic eyes with persistent diffuse diabetic macular edema after intravitreal injection of triamcinolone acetonide, as well as the potential impact of these changes on the intraocular pressure values. In 10 pseudophakic eyes with persistent diffuse diabetic macular edema, paracentesis of anterior chamber with aspiration of aqueous humor and nitric oxide concentration measurements were done on the day of the intravitreal application of 20 mg triamcinolone acetonide, and after 1, 3, 6 and 9 months. Also, we were recording intraocular pressure values before the intravitreal triamcinolone acetonide injection and during the next 9 months. One month after the intravitreal triamcinolone acetonide injection, we noticed a decrease of nitric oxide concentration (45.37±5.55 µmol/L) by 31.79% compared to the initial values (66.52±7.66 µmol/L). After that, nitric oxide concentrations began to rise slightly, and at the end of the ninth month the mean nitric oxide concentration was similar to that recorded at the beginning of the study. Intraocular pressure values had increasing trend one month after the intravitreal triamcinolone acetonide injection (23.70±4.08 mm Hg) compared to the initial values (16.21±1.55 mm Hg), but after nine months these values returned to normal levels. Decreased concentration of nitric oxide could be one of the reasons for increased intraocular pressure after intravitreal application of triamcinolone acetonide in the treatment of diffuse diabetic macular edema.
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Affiliation(s)
- Nenad Petrović
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Dušan Todorović
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Sunčica Srećković
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Svetlana Jovanović
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Marija Petrović
- Department of Laboratory Diagnostics, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Ivan Stojadinović
- Department of Orthopedic Surgery and Traumatology, Kragujevac Clinical Center, Kragujevac, Serbia
| | - Tatjana Šarenac Vulović
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Ophthalmology, Kragujevac Clinical Center, Kragujevac, Serbia
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Yang C, Yang J, Lu A, Gong J, Yang Y, Lin X, Li M, Xu H. Nanoparticles in ocular applications and their potential toxicity. Front Mol Biosci 2022; 9:931759. [PMID: 35911959 PMCID: PMC9334523 DOI: 10.3389/fmolb.2022.931759] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Nanotechnology has been developed rapidly in recent decades and widely applied in ocular disease therapy. Nano-drug delivery systems overcome the bottlenecks of current ophthalmic drug delivery and are characterized with strong biocompatibility, stability, efficiency, sustainability, controllability, and few side effects. Nanoparticles have been identified as a promising and generally safe ophthalmic drug-delivery system based on the toxicity assessment in animals. Previous studies have found that common nanoparticles can be toxic to the cornea, conjunctiva, and retina under certain conditions. Because of the species differences between humans and animals, advanced in vitro cell culture techniques, such as human organoids, can mimic the human organism to a certain extent, bringing nanoparticle toxicity assessment to a new stage. This review summarizes the advanced application of nanoparticles in ocular drug delivery and the potential toxicity, as well as some of the current challenges and future opportunities in nanotoxicological evaluation.
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Affiliation(s)
- Cao Yang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Junling Yang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Ao Lu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Jing Gong
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Yuanxing Yang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xi Lin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Minghui Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
- *Correspondence: Minghui Li, ; Haiwei Xu,
| | - Haiwei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
- *Correspondence: Minghui Li, ; Haiwei Xu,
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Orii Y, Gozawa M, Takamura Y, Takeuchi Y, Morioka M, Yamada Y, Matsumura T, Sugimoto M, Inatani M. Comparison of the intraocular pressure following an intravitreal triamcinolone acetonide injection for diabetic macula oedema in vitrectomised and non-vitrectomised eyes. BMJ Open Ophthalmol 2021; 6:e000620. [PMID: 33490603 PMCID: PMC7798713 DOI: 10.1136/bmjophth-2020-000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the intraocular pressure (IOP) after an intravitreal triamcinolone acetonide (IVTA) between vitrectomised and non-vitrectomised eyes in patients with diabetes and diabetic macular oedema (DME). Design Retrospective comparative study Methods Medical records of 157 patients (157 eyes) with type 2 diabetes who received IVTA for DME were reviewed, and the best-corrected visual acuity, IOP and optical central retinal thickness (CRT) were compared preoperatively, at 1, 4, 12 and 24 weeks after IVTA between the vitrectomised and non-vitrectomised groups. Results IOP significantly increased at 1 (p<0.0001), 4 (p<0.0001), 8 (p<0.0001), 12 (p=0.0019), 16 (p=0.0006) and 20 weeks (p=0.0191) in the non-vitrectomised group, whereas a significant increase was only observed at 1 (p=0.0003) and 4 weeks (p=0.0006) in the vitrectomised group. ΔIOP, IOP changes from baseline, in the non-vitrectomised group was significantly higher than that in the vitrectomised group at 4 (p=0.0014), 8 (p=0.0081), 12 (p=0.0032) and 16 weeks (p=0.0038). No significant difference was observed in logMAR and CRT at any time point after IVTA between the two groups. Conclusions After an initial IVTA, increased IOP and ΔIOP from the baseline IOP were significantly more frequently observed in the non-vitrectomised than that in the vitrectomised group. IVTA is a safer and more effective treatment option for DME in vitrectomised than that in non-vitrectomised eyes.
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Affiliation(s)
- Yusuke Orii
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yuko Takeuchi
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Yutaka Yamada
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
| | - Takehiro Matsumura
- Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | | | - Masaru Inatani
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Japan
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Goyal JL, Agarwal R, Arora R, Jain P, Ghosh B. Evaluation of pattern electroretinogram in retinal vein occlusion treated with intravitreal triamcinolone acetonide. Doc Ophthalmol 2016; 132:167-75. [PMID: 27043028 DOI: 10.1007/s10633-016-9536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate pattern electroretinogram (pattern ERG) and anatomical changes in optical coherence tomography (OCT) in acute retinal vein occlusion with macular oedema after intravitreal triamcinolone acetonide (IVTA) injection. METHODS In this prospective interventional study, 20 patients with acute retinal vein occlusion (branch and central) of less than 1 month duration were evaluated for pattern ERG, best-corrected visual acuity (BCVA), central macular thickness on OCT, and contrast sensitivity (CS) before and 1, 6 and 12 weeks after 1 mg IVTA injection. RESULTS The amplitude of P50 wave (pattern ERG) improved from 3.01 ± 1.22 to 3.56 ± 1.29 µv, mean logMAR BCVA improved from 1.10 ± 0.60 to 0.69 ± 0.45, and CS improved from 0.45 ± 0.41 to 0.79 ± 0.29; mean central macular thickness (CMT) decreased from 515.35 ± 202.83 to 358.35 ± 135.4µ at 12 weeks. All the values were statistically significant (p value < 0.001). CONCLUSION IVTA injection in acute retinal vein occlusion with macular oedema results in electrophysiological (pattern ERG) improvement in addition to anatomical (OCT) improvement.
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Affiliation(s)
- Jawahar Lal Goyal
- Guru Nanak Eye Centre, Maulana Azad Medical College, Maharaja Ranjit Singh Marg, New Delhi, 110002, India
| | - Richa Agarwal
- Guru Nanak Eye Centre, Maulana Azad Medical College, Maharaja Ranjit Singh Marg, New Delhi, 110002, India
| | - Ritu Arora
- Guru Nanak Eye Centre, Maulana Azad Medical College, Maharaja Ranjit Singh Marg, New Delhi, 110002, India
| | - Pooja Jain
- Guru Nanak Eye Centre, Maulana Azad Medical College, Maharaja Ranjit Singh Marg, New Delhi, 110002, India.
| | - Basudeb Ghosh
- Guru Nanak Eye Centre, Maulana Azad Medical College, Maharaja Ranjit Singh Marg, New Delhi, 110002, India
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Yuksel-Elgin C, Elgin C. Intraocular pressure elevation after intravitreal triamcinolone acetonide injection: a Meta-analysis. Int J Ophthalmol 2016; 9:139-44. [PMID: 26949624 DOI: 10.18240/ijo.2016.01.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/24/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide. METHODS Systematic literature review of studies that investigated the effects of an injection of triamcinolone intravitreal triamcinolone acetonide on IOP was conducted according to the Cochrane Collaboration methodology and the reported effects have been analyzed with Meta-analysis. RESULTS We found that the IOP follows an inverted-U shape pattern over time starting with an average value of 14.81±1.22 mm Hg before the injection, rising to a maximum of 19.48±2.15 mm Hg after one month of injection and falling down to 16.16±1.92 mm Hg after 6mo. Moreover, country of study, age, previous history of glaucoma and gender compositions matter for cross-study were different in reported IOP changes. CONCLUSION Our findings may be helpful in determining pressure elevation risk of intravitreal triamcinolone acetonide therapy as well as comparing it with those of more recent therapies such as the anti-vascular endothelial growth factor agents.
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Affiliation(s)
- Cansu Yuksel-Elgin
- Department of Ophthalmology, Sariyer Ismail Akgun Public Hospital, Sariyer-Istanbul 34450, Turkey
| | - Ceyhun Elgin
- Department of Economics, Bogazici University, Istanbul 34342, Turkey
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Ozcaliskan S, Ozturk F, Yilmazbas P, Beyazyildiz O. Effect of dorzolamide-timolol fixed combination prophylaxis on intraocular pressure spikes after intravitreal bevacizumab injection. Int J Ophthalmol 2015; 8:496-500. [PMID: 26085997 DOI: 10.3980/j.issn.2222-3959.2015.03.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 08/18/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the effect of topical dorzolamide-timolol fixed combination prophylaxis on short term intraocular pressure (IOP) changes in patients who had intravitreal bevacizumab injection. METHODS One hundred and fifty one eyes of 151 patients which were followed up in retina clinic in Ulucanlar Eye Training and Research Hospital were evaluated in this study. Patients were divided into two groups. Group 1 consists of 75 patients who had topical dorzolamid-timolol medication two hours before injection; while Group 2 consists of 76 patients without prophylaxis. Demographic data, IOP measurements prior to the injection and one, thirty and sixty minutes and twenty-four hours after the injection were recorded. The data were analyzed using SPSS software version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS There were no significant difference between two groups in age, gender distrubition and indications for injections. The mean IOPs in Groups 1 and 2 prior to the injection (T0) were 17.84±0.43 and 18.15±0.43 mm Hg, one minute after the injection (T1) were 29.75±1.6 and 34.44±1.59 mm Hg, 30min after the injection (T30) were 20.06±0.6 and 21.71±0.59 mm Hg respectively. The mean IOPs were 18.26±0.56 mm Hg in Group 1 and 19.78±0.56 mm Hg in Group 2 sixty minutes after the injection (T60). All IOP values after the injection were compared between two groups, there was a significant difference between two groups only on T1; one minute after the injection (P=0.04). There were a statiscially significant difference between the baseline values and other recorded values; except on T60, in Groups 1 and 2 (P<0.05). CONCLUSION After intravitreal bevacizumab injection; we observe a transient IOP elevation which normalizes about one hour after intravitreal injection. In patients who had topical dorzolamid-timolol combination prophylaxis before injections, a significant decrease is seen in IOP spikes due to this injection. The appropiate approach will monitor IOP after intravitreal injection and evaluate the using prophylactic antiglaucomatous drugs before the injection in patients with ganglion nerve cell damage.
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Affiliation(s)
| | - Faruk Ozturk
- Department of Ophthalmology, Yildirim Beyazit University, Ankara 06830, Turkey
| | - Pelin Yilmazbas
- Eye Clinic, Ulucanlar Eye Training and Research Hospital, Ankara 06230, Turkey
| | - Ozlem Beyazyildiz
- Department of Ophthalmology, Gynecology and Pediactric Diseases Hospital, Samsun 55060, Turkey
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O'Day RF, Barthelmes D, Zhu M, Wong TY, McAllister IL, Arnold JJ, Gillies MC. Intraocular pressure rise is predictive of vision improvement after intravitreal triamcinolone acetonide for diabetic macular oedema: a retrospective analysis of data from a randomised controlled trial. BMC Ophthalmol 2014; 14:123. [PMID: 25335434 PMCID: PMC4223852 DOI: 10.1186/1471-2415-14-123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/25/2014] [Indexed: 01/27/2023] Open
Abstract
Background Intravitreal triamcinolone acetonide (IVTA) is an effective treatment for recalcitrant diabetic macular oedema (DMO). It has been shown to improve vision with benefits persisting up to five years. The most common initial side effect of IVTA treatment is rise in intraocular pressure, occurring in approximately 50% of patients within the first 6 months of treatment. We evaluated whether there is a correlation between the development of intraocular pressure rise and improvement in vision. Methods Analysis of individual data from 33 eyes of 33 participants treated with IVTA for DMO from a prospective, randomised, double-masked, placebo controlled trial. The degree of intraocular pressure (IOP) rise was correlated with improvement in best-corrected visual acuity (BCVA) at 1 and 6 months. Results The proportion of eyes gaining 5 or more logMAR letters was higher in eyes with greater IOP rise (p = 0.044). Better absolute improvement in BCVA at 6 months (p = 0.045) was also found in eyes with greater IOP rise. Regression analyses revealed a correlation between IOP rise of 10 or more mmHg and absolute BCVA improvement at 6 months (odds ratio 1.22, 95% confidence interval 1.01-1.48, p = 0.039), but not at 1 month. Conclusions IOP rise and vision improvement appear to be correlated following IVTA for DMO, suggesting that the mechanisms that cause both may be linked. Trial Registration Clinical trials.gov NCT00167518, September 5, 2005.
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Affiliation(s)
- Roderick F O'Day
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, Australia.
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Marozas LM, Fort PE. Diabetic Retinopathy-Update on Prevention Techniques, Present Therapies, and New Leads. ACTA ACUST UNITED AC 2014; 7:54-58. [PMID: 25419235 DOI: 10.17925/usor.2014.07.01.54] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetic retinopathy is the major ocular complication associated with diabetes, and represents the leading cause of legal blindness in the working-age population of developed countries. Although classically diagnosed based on abnormalities of the retinal microvasculature, diabetic retinopathy is now widely recognized as a neurovascular disease. While all patients with diabetes are at increased risk for eye disease including diabetic retinopathy, proactive measures, and timely intervention can prevent or delay subsequent vision loss. Systemic management of diabetes by combined control of glycemia, blood pressure, and serum lipid levels remains the most important method of preventing diabetic retinopathy onset and progression. Once detected, surgical and medical interventions including photocoagulation, vitrectomy, and intravitral drug injection can help preserve vision. However, the need for improved detection methods and therapies that will allow earlier diagnosis and treatment remains apparent. This review summarizes current techniques for the prevention and intervention for diabetic retinopathy, and examines ongoing developments in the search for new endpoints and therapies as they apply to preventing vision loss associated with diabetes.
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Affiliation(s)
- Lauren M Marozas
- Undergraduate Student, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, US
| | - Patrice E Fort
- Assistant Professor, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, US
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