Diabetic Retinopathy
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1 Diabetic Retinopathy
2 Developments in Ophthalmology Vol. 39 Series Editor W. Behrens-Baumann, Magdeburg
3 Diabetic Retinopathy Volume Editor Gabriele E. Lang, Ulm 35 figures, 3 in color, and 25 tables, 2007 Basel Freiburg Paris London New York Bangalore Bangkok Singapore Tokyo Sydney
4 Gabriele E. Lang Universitätsklinikum Ulm Augenklinik Prittwitzstrasse 43 DE Ulm Library of Congress Cataloging-in-Publication Data Diabetic retinopathy / volume editor, Gabriele E. Lang. p. ; cm. (Developments in ophthalmology, ISSN ; v. 39) Includes bibliographical references and index. ISBN-13: (hardcover : alk. paper) ISBN-10: (hardcover : alk. paper) 1. Diabetic retinopathy. I. Lang, Gabriele E. II. Series. [DNLM: 1. Diabetic Retinopathy therapy. 2. Diabetic Retinopathy diagnosis. W1 DE998NG v / WK 835 D ] RE661.D5D dc Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Disclaimer. The statements, options and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2007 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN ISBN-10: ISBN-13:
5 Contents VII List of Contributors IX Preface Lang, G.E. (Ulm) 1 Pathophysiology of Diabetic Macular Edema Joussen, A.M. (Duesseldorf/Cologne); Smyth, N. (Cologne/Southampton); Niessen, C. (Cologne) 13 Characterization and Relevance of Different Diabetic Retinopathy Phenotypes Cunha-Vaz, J. (Coimbra) 31 Optical Coherence Tomography Findings in Diabetic Retinopathy Lang, G.E. (Ulm) 48 Laser Treatment of Diabetic Retinopathy Lang, G.E. (Ulm) 69 Benefits and Limitations in Vitreoretinal Surgery for Proliferative Diabetic Retinopathy and Macular Edema Joussen, A.M. (Duesseldorf); Joeres, S. (Cologne) 88 Diffuse Diabetic Macular Edema: Pathology and Implications for Surgery Gandorfer, A. (München) 96 Intravitreal Triamcinolone Acetonide for Diabetic Retinopathy Jonas, J.B. (Heidelberg) V
6 111 Use of Long-Acting Somatostatin Analogue Treatment in Diabetic Retinopathy Boehm, B.O. (Ulm) 122 Vascular Endothelial Growth Factor and the Potential Therapeutic Use of Pegaptanib (Macugen ) in Diabetic Retinopathy Starita, C. (Sandwich); Patel, M.; Katz, B.; Adamis, A.P. (New York, N.Y.) 149 Pharmacologic Vitreolysis Gandorfer, A. (München) 157 Treatment of Diabetic Retinopathy with Protein Kinase C Subtype Inhibitor Lang, G.E. (Ulm) 166 Subject Index Contents VI
7 List of Contributors Tony Adamis (OSI) Eyetech, Inc. 3 Times Square New York NY (USA) Bernhard O. Boehm Division of Endocrinology and Diabetes, Ulm University Robert-Koch-Strasse 8 DE Ulm (Germany) José Cunha-Vaz AIBILI Azinhaga Santa Comba, Celas PT Coimbra (Portugal) Arnd Gandorfer Vitreoretinal and Pathology Unit Augenklinik der Ludwig- Maximilians-Universität Mathildenstrasse 8 DE München (Germany) Sandra Joeres, MD Medical Retina Unit Doheny Image Reading Center Doheny Eye Institute University of Southern California 1450 San Pablo Street DEI 3623 Los Angeles CA (USA) Jost B. Jonas Universitäts-Augenklinik Theodor-Kutzer-Ufer 1-3 DE Mannheim (Germany) Antonia M. Joussen Department of Ophthalmology Heinrich-Heine University Duesseldorf Moorenstraße 5 DE Duesseldorf Barrett Katz (OSI) Eyetech, Inc. 3 Times Square New York NY (USA) Gabriele E. Lang Universitätsklinikum Ulm, Augenklinik Prittwitzstrasse 43 DE Ulm (Germany) VII
8 Dr. Carien Niessen Center for Molecular Medicine Cologne (CMMC) University of Cologne, LFI, 5, Room 59 Joseph Stelzmannstrasse 9 Manju Patel Pfizer Inc 50 Pequot Avenue MS 6025-B2234 New London CT (USA) Neil Smyth Department of Developmental and Cell Biology School of Biological Sciences University of Southampton Southampton, Hampshire SO16 7PX (UK) Carla Starita Pfizer Global Research and Development, Building 508/1.75 IPC 613 Ramsgate Road, Sandwich CT13 9NJ Kent (UK) FList of Contributors VIII
9 Preface Over decades, there has been broad interest of ophthalmologists and diabetologists in diabetic retinopathy. Despite markedly improved prognosis for visual problems due to laser treatment and vitrectomy, diabetic retinopathy is still one of the leading causes of blindness worldwide. This book provides profound information about the newest developments in the diagnosis and treatment of diabetic retinopathy. The pathophysiology of diabetic macular edema is complex and not yet fully understood. The current knowledge of mechanisms of development and progression of diabetic macular edema is described. An innovative approach of multimedial mapping methods enables to differentiate between three diabetic retinopathy phenotypes, allowing personalized management strategies. Highresolution imaging by optical coherence tomography provides additional, new information about morphological findings in diabetic retinopathy. In this book, the standards and novel approaches of laser treatment of diabetic retinopathy are described, current surgical options for diabetic retinopathy and treatment techniques discussed, and the pathology of diffuse macular edema and implications for surgery proposed. Additionally, the treatment of diabetic retinopathy with triamcinolone and its complications, as well as the hypothesis for the use of somatostatin analogues are discussed. A new therapeutical approach is the use of vascular endothelial growth factor inhibitors in diabetic macular edema. Latest concepts of posterior vitreous detachment by pharmacological vitreolysis are described. An innovative pharmacological compound, the specific protein kinase C subtype inhibitor ruboxistaurin mesylate, significantly reduces the risk of visual loss in nonproliferative diabetic IX
10 retinopathy and holds promise to improve the visual prognosis in patients with diabetic retinopathy. The book provides an update of new insights into the pathogenesis, diagnosis and especially the treatment of diabetic retinopathy and gives detailed information about latest research achievements. Therefore, it is suitable for general ophthalmologists, retina specialists and diabetologists. It provides a collection of latest findings in diabetic retinopathy by excellent authors, and therefore, deserves the attention of everyone who is interested in this subject. I want to thank all the coworkers for their great efforts in passing on their profound knowledge. The contents of the book will not only advance our understanding of diabetic retinopathy based on the provided knowledge, but also improve our diagnosis and treatment strategies in the permanent efforts to help the numerous patients who suffer from diabetic retinopathy and are threatened by visual problems. Prof. Dr. Gabriele E. Lang, Ulm Preface X
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