[Diabetic retinopathy--pathophysiological knowledge and modern treatment methods]

Diabetic retinopathy (DR) leads to visual impairment in the majority of patients suffering from diabetes mellitus for more than 20 years. Endothelial damage, capillary dropout, and vasoproliferative activity of various growth factors are some of the complex pathophysiologic events that lead to retinal damage. Insufficient blood glucose control and arterial hypertension are the leading risk factors for the progression of DR. Adequate therapeutic measures depend on timely and regular ophthalmologic examination. Laser photocoagulation prevents severe visual loss in about 50% of cases with proliferative DR and high risk factors as defined by the Diabetic Retinopathy Study Group. Dosage of laser treatment depends on the stage and severity of DR and requires appropriate experience of the surgeon. Introduction of modern vitreoretinal surgery has yielded considerable progress in the management of vitreous hemorrhages (VH) and tractional retinal detachment in advanced stages of proliferative DR. Results of vitrectomy in 765 cases with proliferative DR are presented. Visual loss can be prevented in over 70% of cases with simple VH without retinal detachment and limited neovascularization, but in only about 30% of cases of VH complicated with retinal traction detachment and extensive vasoproliferation.