title: Diabetic macular oedema: pathophysiology, management challenges and treatment resistance.
abstract: Diabetic macular oedema (DMO) is the leading cause of vision loss in patients living with diabetes. DMO results from hyperglycaemia-induced activation of pathways that lead to oxidative stress and release of cytokines, impairing the inner and outer blood-retinal barriers. Improved understanding of the pathophysiological mechanisms leading to DMO have led to the development of effective therapies, including vitreoretinal surgery, laser photocoagulation, intravitreal anti-vascular endothelial growth factor drugs and corticosteroids. Advances in imaging, including fluorescein angiography and optical coherence tomography, have also enhanced diagnosis and management of the condition. Despite these advances, there remain patients who do not respond completely to therapy, reflecting the complex pathophysiology of DMO. These patients may be considered treatment-resistant. In this review, we summarise the pathophysiology of DMO, as well as the available treatments and their mechanism of action. Additionally, we focus on treatment-resistant disease and review the literature on potential options for managing this complication of diabetes.
authors.affiliation: Sydney Institute of Vision Science, 13/187 Macquarie Street, Sydney, 2000, NSW, Australia.|Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
authors.forename: Bobak
authors.initials: B
authors.lastname: Bahrami
authors.affiliation: Sydney Institute of Vision Science, 13/187 Macquarie Street, Sydney, 2000, NSW, Australia.|Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
authors.forename: Meidong
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Sydney Institute of Vision Science, 13/187 Macquarie Street, Sydney, 2000, NSW, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hong
authors.affiliation: Sydney Institute of Vision Science, 13/187 Macquarie Street, Sydney, 2000, NSW, Australia. achang@sydneyretina.com.au.|Save Sight Institute, University of Sydney, Sydney, NSW, Australia. achang@sydneyretina.com.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chang
mesh_terms: D000818:Animals; D003930:Diabetic Retinopathy / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D008269:Macular Edema / Q000378:metabolism / Q000503:physiopathology*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D042461:Vascular Endothelial Growth Factor A
keywords: Anti-vascular endothelial growth factor; Diabetic macular oedema; Intravitreal corticosteroids; Laser photocoagulation; Review; Treatment resistance; Vitrectomy