64a800abe301cdd822ef0fee4e60e6c0 292352.pdf f6008576bf7c44186fd5202b9b3acca733fe9263 292352.pdf 8ebbffe91bea77cff93c993d7f45794fbff264caab6eb9b2770e65de4a810ada 292352.pdf Title: New Insights into Treating Early and Advanced StageDiabetic Retinopathy Subject: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the working-age population. The disease progresses slowly, and we can roughly differentiate two stages: early-stage (ESDR), in which there are mild retinal lesions and visual acuity is generally preserved, and advanced-stage (ASDR), in which the structural lesions are significant and visual acuity is compromised. At present, there are no specific treatments for ESDR and the current recommended action is to optimize metabolic control and maintain close control of blood pressure. However, in the coming years, it is foreseeable that therapeutic strategies based in neuroprotection will be introduced in the clinical arena. This means that screening aimed at identifying patients in whom neuroprotective treatment might be beneficial will be crucial. Regarding the treatment of ASDR, the current primary course is based on laser photocoagulation and intravitreal injections of anti-angiogenic factors or corticosteroids. Repeated intravitreal injections of anti-VEGF agents as the first-line treatment would be replaced by more cost-effective and personalized treatments based on the results of “liquid biopsies” of aqueous humor. Finally, topical administration (i.e., eye drops) of neuroprotective, anti-inflammatory and anti-angiogenic agents will represent a revolution in the treatment of DR in the coming decade. In this article, all these approaches and others will be critically discussed from a holistic perspective. Keywords: diabetic retinopathy; diabetic macular edema; treatment; retinal neuroprotection; eye drops; intravitreal injections Author: Rafael Simó and Cristina Hernández Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Aug 2 03:41:59 2022 CEST ModDate: Tue Aug 2 07:24:04 2022 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 830421 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ENXZUH+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 HEJBEF+VnURWPalladioL Type 1 Custom yes yes no 15 0 UZZXFU+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 FCSBIA+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 NVWYZY+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 46 0 CKUPDE+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 DFFJHM+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 77 0 DFFJIN+PalatinoLinotype TrueType WinAnsi yes yes no 80 0 DFFJIP+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 83 0 VVSYYB+EURM10 Type 1 Builtin yes yes no 90 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-30 02:41:55 CEST RepresentationInformation: 292352.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-29 12:38:43 CEST Size: 830421 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 406 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: New Insights for Treating ESDR Destination: section.2 Children: Item: Title: General Goals Destination: subsection.2.1 Item: Title: Systemic Treatments Destination: subsection.2.2 Item: Title: Targeting NVU Destination: subsection.2.3 Item: Title: Advances for Treating ASDR Destination: section.3 Children: Item: Title: General Measures Destination: subsection.3.1 Item: Title: Critical Overview of Current Treatment Destination: subsection.3.2 Children: Item: Title: Laser Treatment Destination: subsubsection.3.2.1 Item: Title: Anti-Angiogenic Treatment Destination: subsubsection.3.2.2 Item: Title: Corticosteroids Destination: subsubsection.3.2.3 Item: Title: Discussion Destination: section.4 Item: Title: References Destination: section.4 Info: Title: New Insights into Treating Early and Advanced StageDiabetic Retinopathy Author: Rafael Simó and Cristina Hernández Subject: Diabetic retinopathy (DR) is the leading cause of preventable blindness in the working-age population. The disease progresses slowly, and we can roughly differentiate two stages: early-stage (ESDR), in which there are mild retinal lesions and visual acuity is generally preserved, and advanced-stage (ASDR), in which the structural lesions are significant and visual acuity is compromised. At present, there are no specific treatments for ESDR and the current recommended action is to optimize metabolic control and maintain close control of blood pressure. However, in the coming years, it is foreseeable that therapeutic strategies based in neuroprotection will be introduced in the clinical arena. This means that screening aimed at identifying patients in whom neuroprotective treatment might be beneficial will be crucial. Regarding the treatment of ASDR, the current primary course is based on laser photocoagulation and intravitreal injections of anti-angiogenic factors or corticosteroids. Repeated intravitreal injections of anti-VEGF agents as the first-line treatment would be replaced by more cost-effective and personalized treatments based on the results of “liquid biopsies” of aqueous humor. Finally, topical administration (i.e., eye drops) of neuroprotective, anti-inflammatory and anti-angiogenic agents will represent a revolution in the treatment of DR in the coming decade. In this article, all these approaches and others will be critically discussed from a holistic perspective. 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