By Francesco Bandello, Marco Attilio Zarbin, Rosangela Lattanzio, Ilaria Zucchiatti
With the introduction of powerful remedies for diabetic retinopathy (DR), a brand new period within the administration of DR has been spread out. Amid the deluge of authorized remedies and promising new techniques, even though, clinicians may well locate it tough to decide on the correct perform in every one person case. the aim of this easy-to-use and richly illustrated guide is to help ophthalmologists in making judgements within the complete administration of DR in line with the easiest on hand facts. functional and whole suggestions are supplied to lead clinicians in analysis, decision-making, and therapy. The guide comprises sensible algorithms and case histories in relation to all phases of DR that in actual fact clarify the development of the disorder and should support the clinician to settle on the easiest healing technique. it is going to be a terrific source for ophthalmologists aiming to supply optimum medical administration for this sight-threatening ailment.
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Extra info for Clinical Strategies in the Management of Diabetic Retinopathy: A step-by-step Guide for Ophthalmologists
Bandello et al. a b c d Fig. 8 Abnormal vessels (arrows) in the superior sector in a young diabetic woman without other retinal lesions. 1). The Early Treatment Diabetic Retinopathy Study Research (ETDRS) Group showed that severe NPDR has a great chance of progression to the high-risk PDR, estimated about 15 and 56 % within 1 and 5 years, respectively, while the very severe NPDR has an increased risk of progression to PDR of about 45 and 71 % within 1 and 5 years, respectively . The proposed classification, defined as the gold standard, even if well exhaustive, resulted to be difficult to remember and complex in the everyday clinical practice.
Diabetes Care 32:2307–2313 12. Zheng Y, He M, Congdon N (2012) The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol 60:428–431 13. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE (2008) The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes. Ophthalmology 115:1859–1868 14. Tapp RJ, Shaw JE, Harper CA et al (2003) The prevalence of and factors associated with diabetic retinopathy in the Australian population.
Increased levels of TNF-alpha is present in the vitreous fluid of diabetic patients . Plasma levels of TNF-alpha correlate with the severity of DR . Blockade of TNF-alpha reduces leukostasis, suppresses blood-retinal barrier breakdown, and reduces ICAM-1 expression . DR traditionally has been considered a microvascular disease; however, new evidence suggests that retinal neurodegenerative changes precede microvascular changes . Glutamate, the major excitatory neurotransmitter in the retina, is abnormally elevated in the extracellular space in diabetes .