Risikofaktoren für die Entstehung und Progression der diabetischen Retinopathie

Abstract

Purpose. Diabetes mellitus is a global disease in which a reduced insulin production or effect affects the blood sugar metabolism. The incidence of the illness is rising steadily. An elevated blood sugar level implies changes in the vascular walls and, in the long term, a reduced blood flow to some ar- eas of the retina As a result, growth factors such as VEGF are overexpressed, which can lead to vitreous haemorrhage and traction-related retinal detachment via the formation of new blood vessels. The aim of this work is to review the literature to discuss the risk factors relevant for the development and progression of diabetic retinopathy. Material and Methods. We carried out a differentiated liter- ature review regarding the risk factors relevant to the devel- opment and/or progression of diabetic retinopathy based on a detailed description of the different forms of diabetes. The different risk factors were discussed and evaluated in the context of the different stages of diabetic retinopathy. Results. The risk of retinal conditions increases with the du- ration of the underlying diabetic disease and a significantly higher blood pressure. In insulin-dependent type 1 diabetics, optimising the time in range can reduce the risk. In type 2 diabetics, whose disease is often associated with obesity and increased blood lipid levels, an increase in physical activity can be useful in addition to optimal blood sugar control. All factors that reduce blood circulation, such as nicotine consumption or an increase in intraocular pressure, are to be regarded as risk factors. The first visible ocular signs of diabetic retinopathy are outpouching of the vascular walls (microaneurysms), the number of which correlates with the risk of progression of the retinal disease. Conclusion. It is crucial to understand the systemic and ocular risk factors to reduce the risk of developing or progressing diabetic retinopathy. A clear risk factor that can be reduced is nicotine. Interrupting an anti-VEGF therapy may lead to the progression of diabetic retinopathy. Keywords Risk factors, diabetic retinopathy, proliferative diabetic retinopathy, development and progression