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Retinal Ischaemia in Diabetic Retinopathy: Understanding and Overcoming a Therapeutic Challenge

Journal

JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 6, Pages -

Publisher

MDPI
DOI: 10.3390/jcm12062406

Keywords

diabetes; diabetic retinopathy; DR; retinal ischaemia; retinal nonperfusion; retinal capillary dropout; diabetic macular ischaemia; DMI; ultra-widefield fluorescein angiography; UWF FFA; FFA; optical coherence tomography angiography; OCTA; OCT angiography; OCT; retinal function

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Background: Retinal ischaemia is a common feature in eyes with diabetic retinopathy (DR), but the understanding of its mechanisms, risk factors, and other characteristics is limited. There is currently no treatment available for revascularization of the ischemic retina. Therefore, research on retinal ischemia is of great importance.
Background: Retinal ischaemia is present to a greater or lesser extent in all eyes with diabetic retinopathy (DR). Nonetheless, our understanding of its pathogenic mechanisms, risk factors, as well as other characteristics of retinal ischaemia in DR is very limited. To date, there is no treatment to revascularise ischaemic retina. Methods: Review of the literature highlighting the current knowledge on the topic of retinal ischaemia in DR, important observations made, and underlying gaps for which research is needed. Results: A very scarce number of clinical studies, mostly cross-sectional, have evaluated specifically retinal ischaemia in DR. Interindividual variability on its natural course and consequences, including the development of its major complications, namely diabetic macular ischaemia and proliferative diabetic retinopathy, have not been investigated. The in situ, surrounding, and distance effect of retinal ischaemia on retinal function and structure and its change over time remains also to be elucidated. Treatments to prevent the development of retinal ischaemia and, importantly, to achieve retinal reperfusion once capillary drop out has ensued, are very much needed and remain to be developed. Conclusion: Research into retinal ischaemia in diabetes should be a priority to save sight.

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