title: Diabetic macular edema: new concepts in patho-physiology and treatment.
abstract: Diabetic macular edema (DME), a serious eye complication caused primarily by hyperglycemia, is one of the major causes of blindness. DME, which is characterized by cystic retinal thickening or lipid deposition, is prone to relapse after successful treatment. DME is a complex pathological process caused by multiple factors, including breakdown of the inner and outer blood-retinal barriers, oxidative stress, and elevated levels of vascular endothelial growth factor which have been demonstrated in both preclinical and clinical studies. Starling's law theory explains many of the features of DME. Early detection and treatment of DME can prevent vision loss. Current effective interventions for DME include treatment of systemic risk factors, such as elevated blood glucose, blood pressure and dyslipidemia. Ophthalmic treatments include laser photocoagulation, surgery and intraocular pharmacotherapy. New drugs, which are given by intraocular injection, have emerged in recent years to become first line treatment for DME that affects the central macula with loss of vision. Laser photocoagulation is still the gold standard of treatment for DME which does not involve the central macular. This review outlines these new treatments with particular emphasis on the optimal timing of how they are given.
authors: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730 PR China ; Macula Research Group, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia.
authors: Xinyuan
authors: X
authors: Zhang
authors: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730 PR China.
authors: Huan
authors: H
authors: Zeng
authors: Discipline of Pathology, School of Medical Sciences and Bosch Institute, The University of Sydney, Sydney, NSW 2006, Australia.
authors: Shian
authors: S
authors: Bao
authors: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730 PR China.
authors: Ningli
authors: N
authors: Wang
authors: Macula Research Group, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia.
authors: Mark C
authors: MC
authors: Gillies
keywords: Apoptosis; Diabetic retinopathy; Microvasculopathy; Neuronal degenerative diseases; Therapeutic strategy