Vascular Complications and Diabetes: Current Therapies and Future Challenges

Diabetic retinal complications, including macular edema (DME) and proliferative diabetic retinopathy (PDR), are the leading cause of new cases of blindness among adults aged 20–74. Chronic hyperglycemia, considered the underlying cause of diabetic retinopathy, is thought to act first through violati...

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Main Authors: Abbott L. Willard, Ira M. Herman
Format: Article
Language:English
Published: Wiley 2012-01-01
Series:Journal of Ophthalmology
Online Access:http://dx.doi.org/10.1155/2012/209538
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author Abbott L. Willard
Ira M. Herman
author_facet Abbott L. Willard
Ira M. Herman
author_sort Abbott L. Willard
collection DOAJ
description Diabetic retinal complications, including macular edema (DME) and proliferative diabetic retinopathy (PDR), are the leading cause of new cases of blindness among adults aged 20–74. Chronic hyperglycemia, considered the underlying cause of diabetic retinopathy, is thought to act first through violation of the pericyte-endothelial coupling. Disruption of microvascular integrity leads to pathologic consequences including hypoxia-induced imbalance in vascular endothelial growth factor (VEGF) signaling. Several anti-VEGF medications are in clinical trials for use in arresting retinal angiogenesis arising from DME and PDR. Although a review of current clinical trials shows promising results, the lack of large prospective studies, head-to-head therapeutic comparisons, and potential long-term and systemic adverse events give cause for optimistic caution. Alternative therapies including targeting pathogenic specific angiogenesis and mural-cell-based therapeutics may offer innovative solutions for currently intractable clinical problems. This paper describes the mechanisms behind diabetic retinal complications, current research supporting anti-VEGF medications, and future therapeutic directions.
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spelling doaj-art-4eda3433243b40d6a06ec9e1ced4ff602025-08-20T03:36:32ZengWileyJournal of Ophthalmology2090-004X2090-00582012-01-01201210.1155/2012/209538209538Vascular Complications and Diabetes: Current Therapies and Future ChallengesAbbott L. Willard0Ira M. Herman1Graduate Program in Cellular and Molecular Physiology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USAGraduate Program in Cellular and Molecular Physiology, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USADiabetic retinal complications, including macular edema (DME) and proliferative diabetic retinopathy (PDR), are the leading cause of new cases of blindness among adults aged 20–74. Chronic hyperglycemia, considered the underlying cause of diabetic retinopathy, is thought to act first through violation of the pericyte-endothelial coupling. Disruption of microvascular integrity leads to pathologic consequences including hypoxia-induced imbalance in vascular endothelial growth factor (VEGF) signaling. Several anti-VEGF medications are in clinical trials for use in arresting retinal angiogenesis arising from DME and PDR. Although a review of current clinical trials shows promising results, the lack of large prospective studies, head-to-head therapeutic comparisons, and potential long-term and systemic adverse events give cause for optimistic caution. Alternative therapies including targeting pathogenic specific angiogenesis and mural-cell-based therapeutics may offer innovative solutions for currently intractable clinical problems. This paper describes the mechanisms behind diabetic retinal complications, current research supporting anti-VEGF medications, and future therapeutic directions.http://dx.doi.org/10.1155/2012/209538
spellingShingle Abbott L. Willard
Ira M. Herman
Vascular Complications and Diabetes: Current Therapies and Future Challenges
Journal of Ophthalmology
title Vascular Complications and Diabetes: Current Therapies and Future Challenges
title_full Vascular Complications and Diabetes: Current Therapies and Future Challenges
title_fullStr Vascular Complications and Diabetes: Current Therapies and Future Challenges
title_full_unstemmed Vascular Complications and Diabetes: Current Therapies and Future Challenges
title_short Vascular Complications and Diabetes: Current Therapies and Future Challenges
title_sort vascular complications and diabetes current therapies and future challenges
url http://dx.doi.org/10.1155/2012/209538
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