Abstract

SO.10.08

Changing paradigms in diabetic retinopathy – new aspects in diagnosis and therapy

Georg Spital, Daniel Pauleikhoff
Augenabteilung am St. Franziskus-Hospital, Münster

Objective
Since the establishment of laser treatment (DRS/ETDRS) in therapy of diabetic retinopathy (DR), the according criteria for diagnosis, classification and therapy have remained nearly unchanged over decades. Recent findings concerning pathogenesis, epidemiological data as well as current diabetologic and ophthalmologic therapy studies reveal new strategies for interdisciplinary prevention and intervention as well as indications for new ophthalmologic diagnostical and therapeutical tools, such as OCT and  intravitreal anti-VEGF (A-VEGF) or corticosteroid-therapy. From analysis of current study data new trends and therapeutic directives will be deduced and demonstrated using concrete case reports.
Methods
Analysis and summary of current study-data concerning risk factors, prevention and therapeutic effects of new diabetologic and ophthalmologic treatment options on formation and course of DR. Derivation of reasonable changes in conventional concepts of  diagnosis and therapy of DR. Demonstration of  these current strategies using case reports.
Results
Current diabetologic treatment studies (e.g. `direct`, `field`, `edic`, `accord`, `advance`) are broadening our comprehension of options for and necessity of a more effective primary and secondary prevention of DR. Target values (HbA1c, art.BP, serum lipids) as well as recommended therapeutic drugs (AT1blockers, fibrates) are changing. In addition controlled studies of A-VEGF (e.g.`resolve`) demonstrate significant visual gain in diabetic ME, whereas evidence is growing on one hand for a transient therapeutical effect as in intravitreal corticoids (as opposed  to laser therapy), and on the other hand for risks concerning long-term treatment of multimorbid diabetics. Although still `off label` in some indications, they complement the gold standard laser treatment. OCT is becoming an integral part of diagnosis and monitoring of DR.
Conclusions
Knowlegde of risk factors, current target values and recommended interdisciplinary approaches in DR is as important to the ophthalmologist as an accurate retinal diagnosis using FLA and OCT. Moreover, new therapeutic options, e.g. A-VEGF, by now provide useful therapeutic complements to laser treatment, if the individual risks (e.g. cerebro-/cardiovascular) are considered.

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