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Diabetic macular ischaemia- a new therapeutic target?

Gemmy Cheung, Chui Ming; Fawzi, Amani; Teo, Kelvin YC; Fukuyama, Hisashi; Sen, Sagnik; Tsai, Wei-Shan; Sivaprasad, Sobha; (2022) Diabetic macular ischaemia- a new therapeutic target? Progress in Retinal and Eye Research , 89 , Article 101033. 10.1016/j.preteyeres.2021.101033. Green open access

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Abstract

Diabetic macular ischaemia (DMI) is traditionally defined and graded based on the angiographic evidence of an enlarged and irregular foveal avascular zone. However, these anatomical changes are not surrogate markers for visual impairment. We postulate that there are vascular phenotypes of DMI based on the relative perfusion deficits of various retinal capillary plexuses and choriocapillaris. This review highlights several mechanistic pathways, including the role of hypoxia and the complex relation between neurons, glia, and microvasculature. The current animal models are reviewed, with shortcomings noted. Therefore, utilising the advancing technology of optical coherence tomography angiography (OCTA) to identify the reversible DMI phenotypes may be the key to successful therapeutic interventions for DMI. However, there is a need to standardise the nomenclature of OCTA perfusion status. Visual acuity is not an ideal endpoint for DMI clinical trials. New trial endpoints that represent disease progression need to be developed before irreversible vision loss in patients with DMI. Natural history studies are required to determine the course of each vascular and neuronal parameter to define the DMI phenotypes. These DMI phenotypes may also partly explain the development and recurrence of diabetic macular oedema. It is also currently unclear where and how DMI fits into the diabetic retinopathy severity scales, further highlighting the need to better define the progression of diabetic retinopathy and DMI based on both multimodal imaging and visual function. Finally, we discuss a complete set of proposed therapeutic pathways for DMI, including cell-based therapies that may provide restorative potential.

Type: Article
Title: Diabetic macular ischaemia- a new therapeutic target?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.preteyeres.2021.101033
Publisher version: https://doi.org/10.1016/j.preteyeres.2021.101033
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Diabetic macular ischaemia, Diabetic macular oedema, Diabetic retinopathy, Foveal avascular zone, Optical coherence tomography, Optical coherence tomography angiography
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10148749
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