The diabetic retinopathy (DR)Â is the most frequent ocular complication among diabetic patients and the leading cause of blindness globally in developing countries. Clinically, DR can present in either non-proliferating form (initial phase) and proliferating (advanced stage). The latter clinical form, which is the most severe, can also lead to serious complications such as vitreous haemorrhage, retinal detachment and not least thediabetic macular oedema (EMD) the most serious of these complications. Epidemiological data indicate that among the world's diabetic population the 34.6% is affected by RDthe 6.96% from proliferating RD and 6.81% from EMD.
The risk factors underlying the onset of these eye diseases are multiple and include not only diabetic pathology, but also a genetic susceptibility. For this reason, predicting the risk of onset of DR and consequently EMD is not as easy as their management. However, medicine has made numerous steps forward in this regard in recent years. In fact, the introduction of new fintravitreal armacies (corticosteroids and anti-VEGF, vascular endothelial growth factor) revolutionised the management of the diabetic patient suffering from DR or EMD, which is now increasingly oriented towards the adoption of personalised therapy.
How the therapy of diabetic retinopathy has changed: from laser photocoagulation to corticosteroid drugs
Laser photocoagulation has for years been considered the therapy par excellence (gold standard) for the treatment of DR and EMD. The first study to demonstrate therapeutic efficacy in subjects with EMD was the ETDRS study (Early Treatment Diabetic Retinopathy Study) in which EMD subjects showed a 50% reduction in the risk of visual loss. The same success in terms of efficacy, however, was not found in terms of safety. Complications associated with laser therapy, indeed, are not few and range from the appearance of scarred retinal areas to altered night vision. For this reason, the identification of new effective and safe therapeutic strategies has led to the development of new drugs in the last few years that can meet this need and cover a wider target population. Anti-VEGF drugs, in fact, have been shown to be more effective than laser treatment and quite safe. In addition, corticosteroid drugs for intravitreal use, including the dexamethasone and fluocinolone acetonide (https://www.oculistaitaliano.it/articoli/edema-maculare-diabetico/). The latter is administered with an implant, which ensures a continuous and prolonged release of the drug over a 36-month coverage period, thus avoiding the need for the patient to undergo continuous courses of therapy with frequent intravitreal injections.
 On what does the choice of treatment for diabetic retinopathy depend?
Before the choice of the therapeutic strategy to be adopted, the specialist must carefully assess the clinical picture of the patient and make as accurate an assessment as possible of the risk factors underlying the onset of the disease. The treatment to be implemented then depends on numerous factors such as baseline visual acuity, response to previous treatments as well as the stage of RD and EMD.
Source
Dr. Carmelo Chines
Direttore responsabile
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