title: Advances in the treatment of diabetic retinopathy.
abstract: Diabetic retinopathy, the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Strict metabolic control, tight blood pressure control, laser photocoagulation, and vitrectomy remain the standard care for diabetic retinopathy. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with diabetic macular edema and should be considered as the first-line therapeutic option. The current evidence suggests that intravitreal triamcinolone acetonide or anti-vascular endothelial growth factor agents result in a temporary improvement of visual acuity and a short-term reduction in central macular thickness in patients with refractory diabetic macular edema and are an effective adjunctive treatments to laser photocoagulation or vitrectomy. However, triamcinolone is associated with risks of elevated intraocular pressure and cataract. Vitrectomy with the removal of the posterior hyaloid without internal limiting membrane peeling seems to be effective in eyes with persistent diffuse diabetic macular edema, particularly in eyes with associated vitreomacular traction. Emerging therapies include islet cell transplantation, fenofibrate, ruboxistaurin, pharmacologic vitreolysis, rennin-angiotensin system blockers, and peroxisome proliferator-activated receptor gamma agonists.
authors: Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Ahmed M
authors: AM
authors: Abu El-Asrar
authors: Hani S
authors: HS
authors: Al-Mezaine
keywords: Diabetic retinopathy; Review; Treatment
references: Lancet. 2008 Oct 18;372(9647):1385-93
references: 18823658
references: Retina. 2009 Apr;29(4):530-5
references: 19357559
references: Eur J Ophthalmol. 2009 Jul-Aug;19(4):618-21
references: 19551678
references: Arch Ophthalmol. 2007 Apr;125(4):469-80
references: 17420366
references: Retina. 2009 Feb;29(2):269-74
references: 19050667
references: BMJ. 1998 Sep 12;317(7160):703-13
references: 9732337
references: Retina. 2010 Oct;30(9):1488-95
references: 20924264
references: Arch Ophthalmol. 2008 Jun;126(6):793-9
references: 18541841
references: N Engl J Med. 1993 Sep 30;329(14):977-86
references: 8366922
references: Lancet. 2008 Oct 18;372(9647):1394-402
references: 18823656
references: Arch Ophthalmol. 1985 Dec;103(12):1796-806
references: 2866759
references: Retina. 2009 Jul-Aug;29(7):926-31
references: 19584650
references: Ophthalmology. 2008 Sep;115(9):1571-80, 1580.e1-3
references: 18440643
references: Ophthalmology. 2009 Oct;116(10):1943-8
references: 19699531
references: Am J Ophthalmol. 2004 Oct;138(4):560-6
references: 15488781
references: Acta Ophthalmol. 2008 Nov;86(7):800-5
references: 18547274
references: Ophthalmology. 2009 May;116(5):902-11; quiz 912-3
references: 19410949
references: Ophthalmology. 2010 Jun;117(6):1087-1093.e3
references: 20299105
references: Can J Ophthalmol. 2009 Oct;44(5):587-93
references: 19789597
references: Arch Ophthalmol. 2009 Mar;127(3):245-51
references: 19273785
references: Arch Ophthalmol. 2006 May;124(5):653-8
references: 16682586
references: Ophthalmology. 2006 Sep;113(9):1533-8
references: 16828501
references: Eye (Lond). 2009 Jan;23(1):117-23
references: 17891058
references: Retina. 2007 Oct;27(8):1090-6
references: 18040251
references: Clin Drug Investig. 2008;28(5):327-32
references: 18407718
references: Diabetes Care. 2003 Jan;26 Suppl 1:S99-S102
references: 12502630
references: Retina. 2009 Apr;29(4):464-72
references: 19289987
references: Arch Ophthalmol. 1998 Jul;116(7):874-86
references: 9682700
references: Lancet. 1998 Sep 12;352(9131):837-53
references: 9742976
references: Ophthalmology. 2008 Sep;115(9):1447-9, 1449.e1-10
references: 18662829
references: N Engl J Med. 2010 Jul 15;363(3):233-44
references: 20587587
references: Ophthalmology. 2009 Nov;116(11):2175-81.e1
references: 19700194
references: Acta Ophthalmol. 2009 Nov;87(7):736-40
references: 18803622
references: Am J Ophthalmol. 2005 Oct;140(4):585-97
references: 16226510
references: Eur J Ophthalmol. 2006 Jan-Feb;16(1):138-40
references: 16496258
references: Ophthalmology. 2009 Jun;116(6):1142-50
references: 19376585
references: Am J Ophthalmol. 2009 Apr;147(4):583-586.e1
references: 19181303
references: Retina. 2009 Apr;29(4):516-22
references: 19262436
references: Br J Ophthalmol. 2009 Nov;93(11):1474-8
references: 19692371
references: Retina. 2008 Mar;28(3):420-6
references: 18327133
references: Graefes Arch Clin Exp Ophthalmol. 2009 Jun;247(6):735-43
references: 19189118
references: Arch Ophthalmol. 2007 Mar;125(3):318-24
references: 17353401
references: Ophthalmology. 2003 Apr;110(4):681-6
references: 12689886
references: Trans Am Ophthalmol Soc. 1996;94:505-37
references: 8981711
references: Am J Ophthalmol. 2007 Jul;144(1):124-6
references: 17601433
references: Arch Ophthalmol. 2008 Dec;126(12):1707-15
references: 19064853
references: Ophthalmology. 2006 Jan;113(1):23-8
references: 16343627
references: Transplantation. 2008 May 27;85(10):1400-5
references: 18497678
references: Ophthalmology. 2010 May;117(5):946-53
references: 20122739
references: Graefes Arch Clin Exp Ophthalmol. 2010 Jun;248(6):785-91
references: 20135139
references: Jpn J Ophthalmol. 2007 Jul-Aug;51(4):285-91
references: 17660989
references: Am J Ophthalmol. 2008 May;145(5):854-61
references: 18328456
references: Acta Ophthalmol. 2008 Jun;86(4):385-9
references: 17995982
references: Arch Ophthalmol. 2009 Feb;127(2):132-40
references: 19204228
references: Br J Ophthalmol. 2008 Jan;92(1):76-80
references: 17965109
references: Retina. 2009 Mar;29(3):292-9
references: 19287286
references: Arch Ophthalmol. 1985 Nov;103(11):1644-52
references: 2865943
references: Jpn J Ophthalmol. 2009 Mar;53(2):120-124
references: 19333695
references: Am J Ophthalmol. 2005 Aug;140(2):295-301
references: 16023067
references: Am J Ophthalmol. 2009 Jun;147(6):1022-30, 1030.e1-5
references: 19327746
references: Ophthalmology. 2006 Dec;113(12):2221-30
references: 16989901
references: J Ocul Pharmacol Ther. 2009 Aug;25(4):379-84
references: 19650710
references: Ophthalmology. 2009 Jun;116(6):1151-7
references: 19376589
references: Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4547-52
references: 17003451
references: Br J Ophthalmol. 2006 Jan;90(1):33-6
references: 16361663
references: Ophthalmology. 2005 Oct;112(10):1747-57
references: 16154196
references: Am J Ophthalmol. 2009 Feb;147(2):291-297.e2
references: 18929352
references: Ophthalmology. 1978 Jan;85(1):82-106
references: 345173
references: Lancet. 1998 Jan 3;351(9095):28-31
references: 9433426
references: Retina. 2007 Oct;27(8):1074-8
references: 18040248
references: Lancet. 2007 Nov 17;370(9600):1687-97
references: 17988728
references: Ophthalmology. 2010 Nov;117(11):2146-51
references: 20855114
references: Am J Ophthalmol. 2005 Oct;140(4):573-84
references: 16125661
references: Retina. 2010 Feb;30(2):254-9
references: 20057344
references: Ophthalmology. 2010 Jun;117(6):1064-1077.e35
references: 20427088
references: Retina. 2009 Sep;29(8):1134-40
references: 19672218
references: Br J Ophthalmol. 2009 Feb;93(2):144-9
references: 19174400
references: Ophthalmology. 2007 Dec;114(12):2162-7
references: 17459479
references: Transplantation. 2008 Dec 27;86(12):1762-6
references: 19104418
references: Ophthalmology. 2006 Oct;113(10):1706-12
references: 17011952
references: Ophthalmology. 2004 Feb;111(2):231-7
references: 15019368
references: Arch Ophthalmol. 2009 Dec;127(12):1566-71
references: 20008708
references: Retina. 2008 Oct;28(9):1314-8
references: 18728621
references: Br J Ophthalmol. 2008 Feb;92(2):213-6
references: 17965108
references: Acta Ophthalmol. 2009 Sep;87(6):623-30
references: 19678810
references: Graefes Arch Clin Exp Ophthalmol. 2009 Feb;247(2):147-63
references: 19034481
references: Invest Ophthalmol Vis Sci. 2009 Jan;50(1):1-4
references: 18708615