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Expert Opin Biol Ther. 2018 Dec;18(12):1257-1270. doi: 10.1080/14712598.2018.1545836. Epub 2018 Nov 14.

Diabetic retinopathy: a complex pathophysiology requiring novel therapeutic strategies.

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a John van Geest Centre for Brain Repair, Department of Clinical Neurosciences , University of Cambridge , Cambridge , UK.
b Centre for Eye Research Australia , University of Melbourne and Royal Victorian Eye and Ear Hospital , Melbourne , Australia.
c Department of Surgery , University of Melbourne , Melbourne , Australia.
d Eye Department , Addenbrooke's Hospital , Cambridge , UK.
e Cambridge NIHR Biomedical Research Centre , Cambridge , UK.
f Wellcome Trust - MRC Cambridge Stem Cell Institute , University of Cambridge , Cambridge , UK.


Diabetic retinopathy (DR) is the leading cause of vision loss in the working age population of the developed world. DR encompasses a complex pathology, and one that is reflected in the variety of currently available treatments, which include laser photocoagulation, glucocorticoids, vitrectomy and agents which neutralize vascular endothelial growth factor (VEGF). Whilst these options demonstrate modest clinical benefits, none is yet to fully attenuate clinical progression or reverse damage to the retina. This has led to an interest in developing novel therapies for the condition, such as mediators of angiopoietin signaling axes, immunosuppressants, nonsteroidal anti-inflammatory drugs (NSAIDs), oxidative stress inhibitors and vitriol viscosity inhibitors. Further, preclinical research suggests that gene therapy treatment for DR could provide significant benefits over existing treatments options. Areas covered: Here we review the pathophysiology of DR and provide an overview of currently available treatments. We then outline recent advances made towards improved patient outcomes and highlight the potential of the gene therapy paradigm to revolutionize DR management. Expert opinion: Whilst significant progress has been made towards our understanding of DR, further research is required to enable the development of a detailed spatiotemporal model of the disease. In addition, we hope that improvements in our knowledge of the condition facilitate therapeutic innovations that continue to address unmet medical need and improve patient outcomes, with a focus on the development of targeted medicines.


Diabetic retinopathy; diabetic macular edema; neovascularization; neuronal apoptosis; vascular endothelial growth factor

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