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Diabetic retinopathy in focus: Update on treatment advances, pharmaceutical approaches, and new technologies
Adela Laura Ciorba1, Sameh Saber2, Amir Mohamed Abdelhamid3
1Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania.
Abstract:
This review provides an updated overview of the pathogenesis, classification, current management, and emerging therapies for diabetic retinopathy (DR). DR development involves dysregulation of the polyol pathway, formation of advanced glycation end products, activation of protein kinase C, and upregulation of vascular endothelial growth factor (VEGF). Disruption of the retinal neurovascular unit, including neurons, glial cells, and vascular elements, also plays a pivotal role, leading to microvascular damage, neurodegeneration, and inflammation. DR progresses from non-proliferative (NPDR) to proliferative stages (PDR) characterized by retinal neovascularization. Management emphasizes glycemic and blood pressure control, with advanced stages treated using laser photocoagulation, vitrectomy, and intravitreal anti-VEGF injections. Novel imaging technologies like optical coherence tomography angiography (OCTA) and electroretinography (ERG) enable early diagnosis and disease monitoring. Genetic factors, including VEGF polymorphisms and genes linked to oxidative stress and angiogenesis, significantly influence DR susceptibility. Innovative treatments under investigation include nanotechnology-based drug delivery, microRNA-targeted therapies, and AAV-mediated gene therapies aimed at anti-angiogenic pathways. Stem cell-based strategies utilizing adipose, bone marrow, amniotic, and umbilical cord-derived. It shows promise for retinal repair and neuroprotection. Future directions encompass CRISPR-Cas9 gene editing for precise genomic interventions, personalized medicine approaches, and integrated screening programs powered by artificial intelligence. A multifaceted approach involving risk factor modification, lifestyle interventions, advanced therapeutics, and cost-effectiveness analysis is essential to reduce the public health burden of diabetic retinopathy.
Insights
Diabetic retinopathy (DR) involves complex pathways leading to vision loss. Current management focuses on control and existing treatments, while emerging therapies like gene therapy and stem cells offer future hope for retinal repair.
Area of Science:
- Ophthalmology
- Endocrinology
- Genetics
Background:
- Diabetic retinopathy (DR) is a leading cause of vision impairment, stemming from complex molecular and cellular disruptions in the retina.
- Key pathogenic mechanisms include metabolic dysregulation (polyol pathway, advanced glycation end products), oxidative stress, and inflammation, impacting the retinal neurovascular unit.
Purpose of the Study:
- To provide an updated overview of diabetic retinopathy pathogenesis, classification, current management strategies, and novel therapeutic approaches.
- To highlight advancements in diagnostic imaging and explore future directions in DR treatment and prevention.
Main Methods:
- Comprehensive literature review of pathogenesis, clinical management, and emerging therapies for diabetic retinopathy.
- Analysis of novel imaging technologies (OCTA, ERG) and genetic factors influencing DR.
- Evaluation of innovative treatments including nanotechnology, gene therapy, and stem cell strategies.
Main Results:
- DR pathogenesis involves intricate pathways and neurovascular unit disruption, progressing from non-proliferative (NPDR) to proliferative stages (PDR).
- Current management combines glycemic/blood pressure control with laser photocoagulation, vitrectomy, and anti-VEGF injections.
- Emerging therapies show promise, including nanotechnology, microRNA and gene therapies, stem cell strategies, and AI-powered screening.
Conclusions:
- Effective DR management requires a multifaceted approach, integrating risk factor modification, current treatments, and innovative therapeutic strategies.
- Advanced diagnostics and personalized medicine, including gene editing, are crucial for reducing the global burden of diabetic retinopathy.
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