Diabetic Retinopathy and Angiogenesis

Abstract

Diabetic retinopathy, a secondary microvascular complication of diabetes mellitus is the leading cause of blindness in the Unites States amongst individuals age 20 to 64. Two major retinal problems cause most of the diabetes-related vision loss: diabetic macular edema and complications from abnormal retinal blood vessel growth, angiogenesis. Secondary to angiogenesis, increased retinal blood flow is of pathogenic importance in the progression of diabetic retinopathy. Understanding the role of hyperglycemia seems to be the most critical factor in regulating retinal blood flow, as increased levels of blood glucose are thought to have a structural and physiological effect on retinal capillaries causing them to be both functionally and anatomically incompetent. High blood glucose induces hypoxia in retinal tissues, thus leading to the production of VEGF-A (vascular endothelial growth factor protein). Hypoxia is a key regulator of VEGF-induced ocular neovascularization. Secondary to the induction of VEGF by hypoxia, angiogenesis can be controlled by angiogenic inducers and inhibitors. The balance between VEGF and angiogenic inhibitors may determine the proliferation of angiogenesis in diabetic retinopathy. Since VEGF-A is a powerful angiogenic inducer, utilizing anti-VEGF treatments has proved to be a successful protocol in the treatment of proliferative diabetic retinopathy.

Fractal, multifractal and lacunarity analysis applied in retinal regionsof diabetic patients with and without non-proliferative diabetic retinopathy

“…This secondary microvascular complication of diabetes mellitus occurs due to the hyperglycemia that promotes structural and functional alteration of retinal capillaries [2]. The early stage of retinopathy is termed as non-proliferative diabetic retinopathy, a disease characterized by microaneurysms, hemorrhages and capillary closure [2,3].…”

Gasotransmitters in Vascular Complications of Diabetes

“…This protection is reflected by the downregulation of p53, vascular endothelial growth factor (VEGF), and HIF-1a and a reduction of diabetes-induced apoptosis in retinal ganglion cells (RGCs). On the contrary, HO-1-derived CO is proangiogenic (65), and angiogenesis, causing increased retinal blood flow, is a key factor in the development of diabetic retinopathy (66). This implies that the proangiogenic effects of CO may actually aggravate diabetic retinopathy.…”

Type-2 Diabetes Mellitus; Frequency of Microalbuminuria in Patients Having Diabetic Retinopathy in Nishter Hospital Multan

“…5 Of these multisystem complications of diabetes, diabetic nephropathy and retinopathy are the most common complications of diabetes mellitus which are associated with significant disease morbidity, poor quality of life, long-term hospitalization and mortality particularly when these lead to ESRD and blindness. 6 Early detection followed by proper treatment and management can help prevent ESRD and blindness. The relationship of diabetic retinopathy and microalbuminuria has been well documented in patients having type 1 diabetes.…”