Microvascular lesions of diabetic retinopathy: clues towards understanding pathogenesis?

Eye (Lond). 2009 Jul;23(7):1496-508. doi: 10.1038/eye.2009.108. Epub 2009 May 15.


Retinopathy is a major complication of diabetes mellitus and this condition remains a leading cause of blindness in the working population of developed countries. As diabetic retinopathy progresses a range of neuroglial and microvascular abnormalities develop although it remains unclear how these pathologies relate to each other and their net contribution to retinal damage. From a haemodynamic perspective, evidence suggests that there is an early reduction in retinal perfusion before the onset of diabetic retinopathy followed by a gradual increase in blood flow as the complication progresses. The functional reduction in retinal blood flow observed during early diabetic retinopathy may be additive or synergistic to pro-inflammatory changes, leucostasis and vaso-occlusion and thus be intimately linked to the progressive ischaemic hypoxia and increased blood flow associated with later stages of the disease. In the current review a unifying framework is presented that explains how arteriolar dysfunction and haemodynamic changes may contribute to late stage microvascular pathology and vision loss in human diabetic retinopathy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Diabetes Mellitus / physiopathology
  • Diabetic Retinopathy / physiopathology*
  • Hemodynamics
  • Humans
  • Hypoxia / etiology
  • Microcirculation / physiology
  • Regional Blood Flow
  • Retinal Vessels / physiology*