Review article
Diabetic retinopathy – pathogenesis and clinical features
Snježana Kaštelan
orcid.org/0000-0002-3983-1157
; Clinics for ophtalmology, General hospital
Martina Tomić
; Department for ophtalmology, Clinics for diabetes, endocrinology and metabolical diseases, School of Medicine, University of Zagreb, Zagreb, Croatia
Željka Rogulja-Pepeonik
; Department for ophtalmology, Clinics for diabetes, endocrinology and metabolical diseases, School of Medicine, University of Zagreb, Zagreb, Croatia
Višnja Mrazovac
; Clinics for ophtalmology, Clinical hospital centre Zagreb, Zagreb, Croatia
Abstract
Diabetic retinopathy, the most common microvascular complication of diabetes mellitus, is estimated to be the leading cause of blindness in the working population in developed countries. The prevalence of retinopathy increases with the duration of diabetes and is
related to hyperglycemia, hypertension, hyperlipidemia, pregnancy, nephropathy and anemia. The retina is a metabolically active tissue, and various biochemical, immunological and genetic mechanisms have been implicated in the pathogenesis of retinopathy. Vascular disruptions are characterized by abnormal autoregulation of retinal blood flow caused by loss of the pericytes, breakdown of the inner blood-retinal barrier, thickening of the capillary basement membrane
as well as damage and proliferation of endothelial cells. Characteristic clinical manifestations are the result of four main processes: the appearance of microaneurysms, increased vascular
permeability, capillary occlusion, and fibrovascular proliferation. The clinical stage of diabetic retinopathy is further divided into nonproliferative and proliferative phases. Diabetic maculopathy
refers to involvement of the macula by oedema and hard exudates (focal, diffuse, exudative) or ischaemia (ischaemic maculopathy). It may accompany both clinical phases of diabetic retinopathy. The most common causes of visual loss in diabetic patients are diabetic
maculopathy and proliferative diabetic retinopathy. Diagnosing diabetic retinopathy and maculopathy requires a combination of clinical examination and diagnostic imaging techniques,
which includes direct or indirect ophthalmoscopy through dilated pupil, color fundus photography, fluorescein angiography, optical coherence tomography and other imaging techniques. All patients with diabetes require frequent ophthalmologic examinations to allow early detection of disease and appropriate intervention in order to prevent blindness.
Keywords
clinical features; diabetic retinopathy; diagnosis; pathogenesis
Hrčak ID:
38808
URI
Publication date:
1.6.2009.
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