Current issue
Archive
Videos
Articles in press
About the journal
Supplements
Editorial board
Reviewers
Abstracting and indexing
Subscription
Contact
Instructions for authors
Publication charge
Ethical standards and procedures
Editorial System
Submit your Manuscript
|
3/2008
vol. 110 abstract:
Review article
Role of the retinal pigment epithelium (RPE) in the pathogenesis and treatment of diabetic macular edema (DME)
Katarzyna Chmielewska
1
,
Jacek Robaszkiewicz
1
,
Mariusz Kosatka
1
Online publish date: 2008/09/15
View
full text
Get citation
ENW EndNote
BIB JabRef, Mendeley
RIS Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
Pigment epithelium-derived factor (PEDF) has recently been shown to be the most potent inhibitor of angiogenesis in the mammalian eye, suggesting that loss of PEDF is involved in the pathogenesis of proliferative diabetic retinopathy. However, a protective role for PEDF in pericyte loss requires elucidation. Present studies suggest that PEDF proteins could protect against advanced glycation end product (AGE), which induce injury in retinal pericytes. Substitution of PEDF proteins may be a promising strategy in the treatment of patients with early diabetic retinopathy. Therefore, injury of RPE is the basic condition, not only of the progress of neovascularization, but initiation of early diabetic microangiopathy and macular edema as well. Recently new intravitreal drugs being used in the treatment of eye diseases with increased level of VEGF. Intravitreally administered a human, monoclonal anti-VEGF agent acts only as symptomatic treatment. It does not eliminate hypoxia and requires repeated
administration. It is worth emphasizing, that VEGF functions are not limited to active angiogenesis, but also seems to require the maintenance and differentiation of mature blood vessels, such as the choriocapillaris. Therefore, delivery of these anti-VEGF treatments needs to be specific to sites of neovascularization or limited to a short duration, to prevent disruption of the normal vasculature. The effective method, which preserves RPE, improves oxygenation and release traction on the macula, leading to decreased permeability with subsequent resolution in DME, is pars plana vitrectomy with ILM peeling. There are several investigations that support the theoretical value of vitrectomy for the treatment of DME. Intraoperative administration of anti-VEGF agent and corticosteroids may additionally improve results of operative treatment. keywords:
pigment epithelium-derived factor, vascular endothelial growth factor, diabetic retinopathy, diabetic macular edema, proliferative vitreoretinopathy, epithelial-mesenchymal transition, pars plana vitrectomy, ILM peeling |
|