Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy

Jacek Szaflik; Marta Misiuk-Hojło; Bożena Romanowska-Dixon; Ewa Mrukwa-Kominek; Joanna Adamiec-Mroczek; Marcin Stopa; Jerzy Mackiewicz; Jerzy Szaflik; Bartłomiej Kopczyński; Filip Szymański; Janusz Gumprecht; Jakub Kałużny

doi:10.5114/ko.2021.111445

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Klinika Oczna / Acta Ophthalmologica Polonica

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4/2021
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Guidelines/recommendations

Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy

Jacek Szaflik

¹

,

Marta Misiuk-Hojło

²

,

Bożena Romanowska-Dixon

^{3, 4}

,

Ewa Mrukwa-Kominek

⁵

,

Joanna Adamiec-Mroczek

²

,

Marcin Stopa

⁶

,

Jerzy Mackiewicz

⁷

,

Jerzy Szaflik

⁸

,

Bartłomiej Kopczyński

¹

,

Filip Szymański

⁹

,

Janusz Gumprecht

¹⁰

,

Jakub Kałużny

¹¹

Department of Ophthalmology, Medical University of Warsaw, SPKSO Ophthalmic University Hospital, Warsaw, Poland
Department and Clinic of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
Department of Ophthalmology and Ocular Oncology, University Hospital in Krakow, Poland
Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Poland
Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
Department of Ophthalmology, Chair of Ophthalmology and Optometry, Heliodor Swiecicki University Hospital, Poznan University of Medical Sciences, Poznan, Poland
Department of Retina and Vitreous Humour Surgery, Medical University of Lublin, Lublin, Poland
Center of Eye Microsurgery Laser Warsaw, Poland
Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Poland
Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
Department of Sense Organ Research, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland

KLINIKA OCZNA 2021, 123, 4: 161-165

DOI: https://doi.org/10.5114/ko.2021.111445

Online publish date: 2021/12/17

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AMA

Szaflik J, Misiuk-Hojło M, Romanowska-Dixon B, et al. Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy. Klinika Oczna / Acta Ophthalmologica Polonica. 2021;123(4):161-165. doi:10.5114/ko.2021.111445.

APA

Szaflik, J., Misiuk-Hojło, M., Romanowska-Dixon, B., Mrukwa-Kominek, E., Adamiec-Mroczek, J.,  & Stopa, M. et al. (2021). Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy. Klinika Oczna / Acta Ophthalmologica Polonica, 123(4), 161-165. https://doi.org/10.5114/ko.2021.111445

Chicago

Szaflik, Jacek, Marta Misiuk-Hojło, Bożena Romanowska-Dixon, Ewa Mrukwa-Kominek, Joanna Adamiec-Mroczek, Marcin Stopa,  and Jerzy Mackiewicz et al. 2021. "Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy". Klinika Oczna / Acta Ophthalmologica Polonica 123 (4): 161-165. doi:10.5114/ko.2021.111445.

Harvard

Szaflik, J., Misiuk-Hojło, M., Romanowska-Dixon, B., Mrukwa-Kominek, E., Adamiec-Mroczek, J., Stopa, M., Mackiewicz, J., Szaflik, J., Kopczyński, B., Szymański, F., Gumprecht, J.,  and Kałużny, J. (2021). Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy. Klinika Oczna / Acta Ophthalmologica Polonica, 123(4), pp.161-165. https://doi.org/10.5114/ko.2021.111445

MLA

Szaflik, Jacek et al. "Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy." Klinika Oczna / Acta Ophthalmologica Polonica, vol. 123, no. 4, 2021, pp. 161-165. doi:10.5114/ko.2021.111445.

Vancouver

Szaflik J, Misiuk-Hojło M, Romanowska-Dixon B, Mrukwa-Kominek E, Adamiec-Mroczek J, Stopa M et al. Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy. Klinika Oczna / Acta Ophthalmologica Polonica. 2021;123(4):161-165. doi:10.5114/ko.2021.111445.

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Diabetic retinopathy – epidemiology

Diabetic retinopathy (DR) remains the leading cause of vision loss in the working age population [1]. The number of patients with diabetes mellitus is growing exponentially, and the WHO has declared the disease a 21st century epidemic. Currently, an estimated 415 million people (8.8% of the population) – or one in 11 of the world’s adults – are living with the disease. In Poland, according to the 2019 National Health Fund (NFZ) report, nearly 3 million people (9.1% of the population) have diabetes [2]. Approximately one in three people with the disease develop diabetic retinopathy. The incidence increases with the duration of the underlying disease. Factors elevating the risk of DR include metabolic decompensation of the underlying disease, abnormal lipid profile, as well as arterial hypertension. Unfortunately, some diabetic patients, despite normal parameters determined in the evaluations listed above, develop microangiopathy. Therefore, the role of partially identified genetic factors predisposing to the development of vascular complications of diabetes mellitus is being increasingly highlighted.

Diabetic retinopathy – classification

Classification of the severity of diabetic retinopathy is based primarily on the analysis of ophthalmoscopy fundus images, as well as the results of retinal optical coherence tomography and fluorescein angiography (Table I) [1].
Typical signs of non-proliferative DR include microaneurysms, intraretinal hemorrhages, hard exudates (lipid and protein deposits), cotton wool spots (axoplasmic stasis in the ganglion cell layer secondary to retinal ischemia), venous dilation and beading, and intraretinal vascular abnormalities. Hard exudates associated with DR reflect an increase in vascular permeability secondary to vascular injury. Their presence is indicative of current or prior diabetic macular edema.
In the advanced stage of DR (proliferative diabetic retinopathy, PDR), the dominant feature of the disease is neovascularization. Changes of this type arise from the presence of large ischemic retinal areas secondary to the occlusion of damaged peripheral capillaries. Depending on its location, the observed neovascularization is divided into two types: new vessels on the disc (NVD) and new vessels elsewhere (NVE). Typically, NVE develops at the junction between normally perfused and ischemic retinal regions.
Diabetic macular edema (DME) is a distinct type...

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Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy

Jacek Szaflik 1 , Marta Misiuk-Hojło 2 , Bożena Romanowska-Dixon 3, 4 , Ewa Mrukwa-Kominek 5 , Joanna Adamiec-Mroczek 2 , Marcin Stopa 6 , Jerzy Mackiewicz 7 , Jerzy Szaflik 8 , Bartłomiej Kopczyński 1 , Filip Szymański 9 , Janusz Gumprecht 10 , Jakub Kałużny 11

Diabetic retinopathy – epidemiology

Diabetic retinopathy – classification