[On the threshold of new treatment of diabetic retinopathy]

The introduction of ocular photocoagulation, almost thirty years ago, was the first successful prevention of blindness from diabetic retinopathy in some patients. The development of lasers, and the growing knowledge of indications for their application, reached the point at which the growth of new blood vessels could be stopped or reversed, and legal blindness from macular oedema avoided in about half of the treated eyes. The attempts at the very prevention of diabetic retinal microvascular complications at some more physiological, even molecular level, aside from the palliative treatment by photocogulation, brought some new and exciting results which are reviewed here. First, and foremost, is the understanding of the importance of the tight blood glucose control which, if started early and kept long enough, slows down the development of retinal lesions and offers a better prognosis for vision in a substantial number of diabetic patients. Second, the development of a unique animal model of proliferative retinopathy which mirrors human disease both chemically and histopathologically offers a field for investigation of both pathogenesis and therapy of this most dreadful complication of diabetes. Finally, there is a bulk of new evidences about the key role of vascular endothelial growth factor/vascular permeability factor in ocular angiogenesis which will probably result in the new approach to the prevention of neovascular growth by inhibition or modulation of VEGF/VPF activity.