Early-stage diabetic retinopathy: gut-metabolic triggers, immune-neurodegeneration, and interventions

Diabetic retinopathy (DR) is a major cause of blindness in the working-age population globally, with its prevalence steadily increasing. This study comprehensively reviews the pathogenesis and progression of DR through a literature review and reveals that chronic hyperglycemia, inflammation, oxidative stress, and dysregulation of gut microbiota and their metabolites in diabetes mellitus (DM) play significant roles in triggering ocular immune activation and early retinal neurodegeneration related to DR. The study details the processes of ocular immune activation and early retinal neurodegeneration influenced by these causative factors and explores potential future therapeutic strategies. Ultimately, this work aims to promote effective early intervention strategies for preventing DR onset and progression.