Current and future pharmacological intervention for diabetic retinopathy

Abstract

Diabetic retinopathy (DR) is a potentially visually devastating complication of chronic hyperglycaemia. Prospective, randomised clinical trials have delineated the standard prevention protocols, including intensive glycaemic, blood pressure, and lipid control, and laser photocoagulation treatment for neovascularisation and clinically significant macular oedema. However, despite these interventions, vision loss from DR still occurs at an alarming rate. Researchers have directed their efforts towards better understanding the specific biological and chemical changes occurring in DR to develop more targeted pharmacological prevention and treatment strategies. This review of diabetic retinopathy will primarily detail the therapies in development at present, including aldose reductase inhibitors, advanced glycosylation end product inhibitors, antioxidants, supplemental oxygen, growth factor modulators including vascular endothelial growth factor inhibitors and protein kinase C inhibitors, extracellular matrix modifiers including corticosteroids, and vitreous modulators. The experimental therapies alter several different pathways that lead to DR. Future research will further delineate these pathways, and therapy is likely to involve arresting several different promoters of DR.

Keywords: 3-hydroxy-3methyl-glutaryl coenzyme A reductase inhibitor,:

• advanced glycosylation end product inhibitor
• aldose reductase inhibitor
• angiotensin-converting enzyme inhibitor
• angiotensin II receptor blocker
• clinically significant macular oedema
• corticosteroid
• enzymatic vitreolysis
• proliferative diabetic retinopathy
• protein kinase C
• vascular endothelial growth factor