Advances in biochemical mechanisms of diabetic retinopathy

Diabetes mellitus is a major cause of blindness in the working population of the Western World. Numerous large, prospective, randomized clinical trials have delineated the current standard prevention and treatment protocols including intensive glycemic and blood pressure control as well as laser photocoagulation for clinically significant macular edema and/or proliferative retinopathy at a high risk for tractional retinal detachment. However, despite all these interventions, vision loss from diabetic retinopathy still occurs at an alarming rate and no data provide an adequate explanation for the serious and rapid involvement of the retinal microcirculation that may be observed in the disease despite a good metabolic control. In fact, there is now ample of evidence that the development of diabetic retinopathy is a multifactorial process where genetic, metabolic and growth factors play an important role. Some biochemical mechanisms, supposed to be involved in the pathogenesis of diabetic retinopathy, have been highlighted in this review.