Neurodegeneration as an early event in diabetic retinopathy.

f l t i s e r m s c i t d o o ( t m s a e Diabetic retinopathy (DR) remains the leading cause of blindness among working-age people in developed countries1. Tight control of blood glucose levels and blood pressure is essential for preventing or arresting DR development. However, therapeutic objectives are difficult to achieve and DR therefore occurs in a high proportion of patients. Once DR appears, laser photocoagulation is still the main tool in the therapeutic armamentarium. The aim of laser photocoagulation is not to improve visual acuity, but to stabilize DR, thus preventing severe visual loss. When laser photocoagulation is timely indicated, the 5-year risk of blindness is decreased by 90%, and visual acuity loss is reduced by 50% in patients with macular edema2. However, laser photocoagulation is often not timely performed, and its effectiveness in current clinical practice is therefore significantly lower. In addition, laser photocoagulation destroys a part of the healthy retina and side effects such as visual acuity loss, impairment in both dark adaptation and color vision, and visual field loss may thus occur. Intravitreal corticosteroids have successfully been used in eyes with persistent diabetic macular edema and vision loss following failure of conventional treatment. However, reinjections are commonly needed, and there are significant adverse effects such as infection, glaucoma, and cataract