Dijabetička retinopatija najčešća je mikrovaskularna komplikacija šećerne bolesti i jedan od vodećih uzroka novonastale sljepoće radno sposobnih osoba u razvijenim zemljama. Prevalencija retinopatije u oba tipa dijabetesa povećava se s trajanjem šećerne bolesti, a njena je učestalost usko povezana s nazočnošću hiperglikemije, hipertenzije, hiperlipidemije, trudnoće, nefropatije i anemije. Glavni uzroci gubitka vida u ovih bolesnika su dijabetička makulopatija i proliferativna dijabetička retinopatija. Za očuvanje i poboljšanje vidne oštrine oboljelih nužno je smanjiti povećanu propusnost stijenki krvnih žila i makularni edem, poboljšati perfuziju retine, smanjiti retinalnu ishemiju i razvoj neovaskularizacija te spriječiti nastanak vitrealnog krvarenja i trakcijskog odignuća retine. Sprječavanje nastanka i usporavanje razvoja dijabetičke retinopatije strogom kontrolom i regulacijom poznatih čimbenika rizika primarni je cilj liječenja. Laser fotokoagulacija retine trenutno je osnovna metoda liječenja makularnog edema i ranih stadija proliferativne dijabetičke retinopatije, dok se u slučajevima uznapredovale bolesti s dugotrajnim vitrealnim krvarenjem i/ili trakcijskim odignućem retine primjenjuje operativni zahvat pars plana vitrektomija. Boljim razumijevanjem patofizioloških mehanizama nastanka i razvoja dijabetičke retinopatije omogućen je razvoj novih metoda liječenja primjenom različitih farmakoloških tvari, među kojima su najznačajniji kortikosteroidi, antagonisti vaskularnog endotelnog čimbenika rasta (anti-VEGF) i lijekovi koji djeluju na biokemijske puteve nastanka dijabetičke retinopatije poput inhibitora protein kinaze C, analoga somatostatina, inhibitora aldoza reduktaze i inhibitora krajnjih produkta glikacije.Diabetic retinopathy, the main microvascular complication of diabetes mellitus, is also estimated to be the leading cause of new blindness in the working population of developed countries. The prevalence of retinopathy in both types of diabetes increases with the duration of diabetes and is highly related to hyperglycemia, hypertension, hyperlipidemia, pregnancy, nephropathy and anemia. The most common causes of visual loss in diabetic patients are diabetic maculopathy and proliferative diabetic retinopathy. Therefore, the main goal of treatment in protecting or improving vision in these patients is to reduce vascular leakage and macular edema, retinal ischemia and growth of fragile new vessels. This would in turn prevent vitreous hemorrhages and tractional retinal detachment. The first step in managing diabetic retinopathy is to reduce the risk of retinopathy development and progression by controlling and treating the underlying risk factors. Laser photocoagulation is the primary method of treatment of macular edema and early stages of proliferative diabetic retinopathy, while pars plana vitrectomy is reserved for severe complications such as severe persistent vitreous hemorrhages or/and tractional retinal detachment. However, more recently, many researches have directed their efforts towards better understanding the microvascular changes in diabetic retinopathy in order to develop more effective pharmacologic prevention and treatment, and determine new treatment strategies. The three major classes of agents currently being studied are: corticosteroids, vascular endothelial growth factor antagonists and agents that are involved in biochemical pathways (protein kinase C inhibitors, somatostatine analogue, aldose reductase and advanced glycation end products inhibitors)
