The pathogenesis of early retinal changes of diabetic retinopathy

Doc Ophthalmol. 2012 Feb;124(1):15-26. doi: 10.1007/s10633-011-9305-y.


Recent successful trials of antibodies to vascular endothelial growth factor (VEGF) in diabetic retinopathy implicate this cytokine as a major cause of diabetic retinopathy (DR) and diabetic macular oedema (DME). The mechanisms which cause VEGF to be over-expressed to cause the vasculopathy are not entirely clear. This review explores the earliest changes to the retina in DR and the factors that predispose or prevent DR, including sleep apnoea, receptor degenerations laser treatment and VEGF polymorphism. The review also presents the evidence that retinal hypoxia, existing in the earliest stages, causes DR. This hypoxia is much increased by dark adaptation, indicating a new and possibly superior therapy.

Publication types

  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use
  • Animals
  • Dark Adaptation / physiology
  • Diabetic Retinopathy* / genetics
  • Diabetic Retinopathy* / metabolism
  • Diabetic Retinopathy* / pathology
  • Gene Expression Regulation
  • Humans
  • Retina / metabolism
  • Retina / pathology*
  • Time Factors
  • Vascular Endothelial Growth Factor A* / antagonists & inhibitors
  • Vascular Endothelial Growth Factor A* / genetics
  • Vascular Endothelial Growth Factor A* / metabolism


  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A