Management of Diabetic Retinopathy in Advanced Stages: A Brief Review

Le résumé fourni par la source

Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in adults worldwide.It is estimated that between 20% and 30% of patients with diabetes mellitus will develop some form of DR during their lifetime.In advanced stages characterized by proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) serious complications such as vitreous hemorrhage, tractional retinal detachment and aberrant neovascularization occur, significantly compromising visual acuity.Management of these conditions requires a multidisciplinary approach that includes strict metabolic control, intravitreal pharmacotherapy and surgical interventions.Anti-VEGF agentes such as ranibizumab, aflibercept and bevacizumab have demonstrated efficacy in reducing edema and stabilizing vision in the short-and medium-term, although their frequent administration and high cost may limit patient adherence.Intravitreal corticosteroids offer an alternative in cases of insufficient response to anti-VEGF therapy but carry risks of cataract and intraocular hypertension, necessitating careful monitoring.Panretinal photocoagulation remains the first-line method for controlling neovascularization in resource-limited settings, despite side effects like peripheral visual field constriction.Vitrectomy is indicated for persistent vitreous hemorrhage and tractional detachments, with better outcomes when combined with perioperative anti-VEGF treatment.Advances in diagnostics such as optical coherence tomography (OCT) and OCT angiography enhance disease monitoring and guide therapeutic decisions.However, socioeconomic and structural barriers, particularly in low-and middle-income countries, hinder access to these technologies and treatments, compromising prognosis.Finally, teleophthalmology and research into gene therapies and novel angiogenic modulators emerge as promising strategies to expand care coverage and improve long-term visual outcomes.

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