Impact of intravitreal pharmacotherapies including antivascular endothelial growth factor and corticosteroid agents on diabetic retinopathy

Abstract

Accumulating data indicate that the threshold to initiate ocular-specific pharmacologic treatment for diabetic retinopathy, previously predominately limited to eyes with visual loss because of center-involved DME or proliferative diabetic retinopathy, is being lowered to earlier stages of diabetic retinopathy. Ongoing clinical trials and secondary analyses continue to further explore the impact and durability of vascular endothelial growth factor blockade and corticosteroids on modification of diabetic retinopathy and the underlying retinal vasculature itself.

Pathophysiology of Diabetic Retinopathy: The Old and the New

“…The levels of pro-inflammatory cytokines and chemokines, such as monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6, are elevated in eyes with DR [ 40 ]. The pivotal functions of inflammation in the initiation and progression of DR have been corroborated empirically with the therapeutic efficacy of corticosteroids for DME and DR per se [ 41 ]. In diabetic retinas, the adhesion and infiltration of leukocytes might damage vascular ECs and neuroglial cells by physical occlusion of capillaries and through the release of inflammatory mediators and superoxide [ 42 ].…”

Effect of NADPH oxidase 1 and 4 blockade in activated human retinal endothelial cells

“…Thus, the first biological drugs to be applied successfully to the treatment of retinal vasculopathy block the action of VEGF. [8][9][10] Other biologically targeted pharmaceuticals are at various stages in the development pipeline, including drugs that directly target the production of ROS. 11 ROS include radicals and non-radicals: superoxide, hydrogen peroxide, hydroxyl radical, peroxynitrite and hypochlorous acid.…”

Retinal endothelial cell phenotypic modifications during experimental autoimmune uveitis: a transcriptomic approach

“…The association of sustained inflammation with angiogenesis is now well established [62] and an interplay is described in the pathogenesis of major retinal diseases. These connections between inflammation and angiogenesis are reflected by the efficacy of steroids in diabetic retinopathy [63] and of anti-VEGF in some uveitis patients [64].…”