Diabetic retinal complications, including macular edema (DME) and proliferative diabetic retinopathy (PDR), are the leading\r\ncause of new cases of blindness among adults aged 20ââ?¬â??74. Chronic hyperglycemia, considered the underlying cause of diabetic\r\nretinopathy, is thought to act first through violation of the pericyte-endothelial coupling. Disruption of microvascular integrity\r\nleads to pathologic consequences including hypoxia-induced imbalance in vascular endothelial growth factor (VEGF) signaling.\r\nSeveral anti-VEGF medications are in clinical trials for use in arresting retinal angiogenesis arising from DME and PDR.\r\nAlthough a review of current clinical trials shows promising results, the lack of large prospective studies, head-to-head therapeutic\r\ncomparisons, and potential long-term and systemic adverse events give cause for optimistic caution. Alternative therapies\r\nincluding targeting pathogenic specific angiogenesis andmural-cell-based therapeutics may offer innovative solutions for currently\r\nintractable clinical problems. This paper describes the mechanisms behind diabetic retinal complications, current research\r\nsupporting anti-VEGF medications, and future therapeutic directions.
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