Diabetic retinopathy

Purpose To describe the clinical stages of diabetic retinopathy (DR) and diabetic macular edema (DME), their complications and treatment. Methods Diabetic retinopathy is currently classified into several groups: minimal non‐proliferative, moderate non‐proliferative, severe non‐proliferative and proliferative with or without high‐risk characteristics. To characterize the severity of DME and for treatment guidelines, the term clinically significant macular edema (CSME) is used. CSME is further classified into focal or diffuse. Results The role of panretinal photocoagulation in reducing the risk of severe visual loss related to proliferative diabetic retinopathy has been demonstrated by prospective large scale randomized studies (DRS, ERTDS). Similarly, the ETRDS study showed the benefit of focal/grid laser photocoagulation in reducing the risk of moderate visual loss in CSME. In the last years, promising results have been published on the use of intravitreal (IVT) injections of triamcilone acetonide, anti‐VEGF agents, and on the use injectable sustained release steroid implants in terms of visual gain and reduction of central macular thickness. Laser photocoagulation was demonstrated more effective that IVT triamcinolone alone for the treatment of diabetic macular oedema. The risks and benefits of novel treatment modalities and their efficacy and safety should be further evaluated in prospective well designed studies. Vitrectomy is indicated in selected cases. Conclusion Diabetic retinopathy is characterized by gradually progressive alterations in the retinal microvasculature leading to neovascularization, vitreous hemorrhage, retinal detachment and macular edema. Several treatment modalities are still investigated. Laser photocoagulation is the standard of care.