• FIROZ MV Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
  • VISHAL GUPTA N Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
  • SANDEEP KANNA Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.


The drastically increasing issues of the disease scenario currently are with different types of diabetes all over the world. It has been reported, approximately 592 million are suffering from the disease throughout the world. It affects differently in different patients with the disease. There have been reports that it is affected differently and also has different side effects. It is also been reported that diabetes mellitus leads to the cause of diabetic retinopathy (DR) and also diabetic macular edema. It is considered as one of the most common causes which is linked to DR. DR has been considered as one of the most important causes for the loss of vision or impaired vision. The drugs show different types of incompatibility such as toxicity, solubility issues, aggregation, and chemical degradation these can be improved by applying several methods. DR is classified according to “Airlie House” into different categories and based on different strategies and consideration. It was found that DR is the main cause for vision loss and also there no much strategies for development of new treatment. The treatment involved is laser photocoagulation and vitrectomy, among these the effective treatment, was found to be laser photocoagulation. This is mainly characterized as proliferative and non-proliferative DR. Different therapeutic agents have been taken for the study these includes vascular endothelial growth factor, renin-angiotensin system inhibitors and nonsteroidal anti-inflammatory drugs, they are certainly different interventions for the treatment, they are nanotechnology and liposome. Nanotechnology applied is the most effective and also acceptable way of treatment.

Keywords: Diabetic macular, edema,, Diabetic retinopathy,, Nonsteroidal anti-inflammatory,


1. Zhang J, Liu R, Kuang HY, Gao XY, Liu HL. Protective treatments and their target retinal ganglion cells in diabetic retinopathy.Brain Res Bull 2017;132:53-60.
2. Pal S, Gautam S, Mishra A, Maurya R, Srivastava AK. Antihyperglycemic and antidyslipidemic potential of Ipomoea batatas leaves in validated diabetic animal models. Int J Pharm Pharm Sci 2015;7:176-86.
3. Salwe KJ, Sachdev DO, Bahurupi Y, Kumarappan M. Evaluation of antidiabetic, hypolipedimic and antioxidant activity of hydroalcoholic extract of leaves and fruit peel of Punica granatum in male wistar albino rats. J Nat Sci Biol Med 2015;6:56-62.
4. Madsen-Bouterse SA, Kowluru RA. Oxidative stress and diabetic retinopathy: Pathophysiological mechanisms and treatment perspectives. Rev Endocr Metab Disord 2008;9:315-27.
5. Kim J, Moon E, Kim TH. Successful midterm management with an herbal decoction, modified-Goshajinkigan (mGJG) for non-proliferative diabetic retinopathy: A case study. Explore (NY) 2018;14:295-9.
6. Nakao S, Yoshida S, Sonoda KH. An overview of diabetic retinopathy. In: Nutritional and Therapeutic Interventions for Diabetes and Metabolic Syndrome. 2nd ed. London: Academic Press, An Imprint of Elsevier; 2018. p. 139-54.
7. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556-64.
8. Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al. Retinopathy in diabetes. Diabetes Care 2004;27 Suppl 1:S84-7.
9. Hernández C, Simó-Servat O, Simó R. Somatostatin and diabetic retinopathy: Current concepts and new therapeutic perspectives. Endocrine 2014;46:209-14.
10. Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: Pathophysiology, screening, and novel therapies. Diabetes Care 2003;26:2653-64.
11. Kane FE, Burdan J, Cutino A, Green KE. Iluvien: A new sustained delivery technology for posterior eye disease. Expert Opin Drug Deliv 2008;5:1039-46.
12. Fangueiro JF, Silva AM, Garcia ML, Souto EB. Current nanotechnology approaches for the treatment and management of diabetic retinopathy. Eur J Pharm Biopharm 2015;95:307-22.
13. Uchegbu IF, Schätzlein AG, Cheng WP, Lalatsa A, editors. Fundamentals of Pharmaceutical Nanoscience. New York: Springer Science & Business Media; 2013.
14. Rosberger DF. Diabetic retinopathy: Current concepts and emerging therapy. Endocrinol Metab Clin North Am 2013;42:721-45.
15. Goldberg MF, Fine SL, editors. Symposium on the Treatment of Diabetic Retinopathy. Arlington, Va.: US Neurological and Sensory Disease Control Program; 1969.
16. Gupta A, Chhikara R. Diabetic retinopathy: Present and past. Procedia Comput Sci 2018;132:1432-40.
17. Agurto C, Murray V, Barriga E, Murillo S, Pattichis M, Davis H, et al. Multiscale AM-FM methods for diabetic retinopathy lesion detection. IEEE Trans Med Imaging 2010;29:502-12.
18. Bitirgen G, Ozkagnici A, Malik RA, Kerimoglu H. Corneal nerve fibre damage precedes diabetic retinopathy in patients with type 2 diabetes mellitus. Diabet Med 2014;31:431-8.
19. Petropoulos IN, Green P, Chan AW, Alam U, Fadavi H, Marshall A, et al. Corneal confocal microscopy detects neuropathy in patients with type 1 diabetes without retinopathy or microalbuminuria. PLoS One 2015;10:e0123517.
20. Srinivasan S, Dehghani C, Pritchard N, Edwards K, Russell AW, Malik RA, et al. Ophthalmic and clinical factors that predict four-year development and worsening of diabetic retinopathy in type 1 diabetes. J Diabetes Complications 2018;32:67-74.
21. Tan NYQ, Tham YC, Ding Y, Yasuda M, Sabanayagam C, Saw SM, et al. Associations of peripapillary atrophy and fundus tessellation with diabetic retinopathy. Ophthalmol Retina 2018;2:574-81.
22. Wong TY, Klein R, Islam FM, Cotch MF, Folsom AR, Klein BE, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol 2006;141:446-55.
23. Grading diabetic retinopathy from stereoscopic color fundus photographs – an extension of the modified airlie house classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:786-806.
24. Kempen JH, O’Colmain BJ, Leske MC, Haffner SM, Klein R, Moss SE, et al. The prevalence of diabetic retinopathy among adults in the United States. Arch Ophthalmol 2004;122:552-63.
25. Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, et al. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: Systematic review and economic evaluation. Health Technol Assess 2015;19:v-xxviii, 1-247.
26. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of diabetic retinopathy study (DRS) findings, DRS report number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981;88:583-600.
27. Lövestam-Adrian M, Agardh CD, Torffvit O, Agardh E. Type 1 diabetes patients with severe non-proliferative retinopathy may benefit from panretinal photocoagulation. Acta Ophthalmol Scand 2003;81:221-5.
28. Stenkula S. Photocoagulation in diabetic retinopathy. A multicentre study in Sweden. Acta Ophthalmol Suppl 1984;162:1-100.
29. Funatsu H, Yamashita H. Pathogenesis of diabetic retinopathy and the renin-angiotensin system. Ophthalmic Physiol Opt 2003;23:495-501.
30. Bresnick GH. Diabetic macular edema. A review. Ophthalmology 1986;93:989-97.
31. Helfgott A, Helfgott AE, Mullany S. Using mathematics to avoid blindness in diabetics. J Model Ophthalmol 2018;2:42-70.
32. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994;331:1480-7.
33. Stitt AW, Lois N, Medina RJ, Adamson P, Curtis TM. Advances in our understanding of diabetic retinopathy. Clin Sci (Lond) 2013;125:1-7.
34. Shepro D, Morel NM. Pericyte physiology. FASEB J 1993;7:1031-8.
35. Fangueiro JF, Andreani T, Egea MA, Garcia ML, Souto SB, Silva AM, et al. Design of cationic lipid nanoparticles for ocular delivery: Development, characterization and cytotoxicity. Int J Pharm 2014;461:64-73.
36. Nathan DM; DCCT/EDIC Research Group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: Overview. Diabetes Care 2014;37:9-16.
37. Porta M, Bandello F. Diabetic retinopathy: A clinical update. Diabetologia 2002;45:1617-34.
38. Beulens JW, Patel A, Vingerling JR, Cruickshank JK, Hughes AD, Stanton A, et al. Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: A randomised controlled trial. Diabetologia 2009;52:2027-36.
39. Progression of retinopathy with intensive versus conventional treatment in the diabetes control and complications trial. Diabetes control and complications trial research group. Ophthalmology 1995;102:647-61.
40. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53.
41. Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM; UK Prospective Diabetes Study Group. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol 2004;122:1631-40.
42. Indications for photocoagulation treatment of diabetic retinopathy: Diabetic retinopathy study report no. 14. The Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin 1987;27:239-53.
43. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:766-85.
44. Tzekov R, Arden GB. The electroretinogram in diabetic retinopathy. Surv Ophthalmol 1999;44:53-60.
45. Waring GO 3rd, Rodrigues MM. Patterns of pathologic response in the cornea. Surv Ophthalmol 1987;31:262-6.
46. Javitt JC, Aiello LP. Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996;124:164-9.
47. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. VI. Retinal photocoagulation. Ophthalmology 1987;94:747-53.
48. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.
49. Stewart MW. Treatment of diabetic retinopathy: Recent advances and unresolved challenges. World J Diabetes 2016;7:333-41.
50. Sinawat S, Rattanapakorn T, Sanguansak T, Yospaiboon Y, Sinawat S. Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation. Eye (Lond) 2013;27:1391-6.
51. Figueira J, Silva R, Henriques J, Caldeira Rosa P, Laíns I, Melo P, et al. Ranibizumab for high-risk proliferative diabetic retinopathy: An exploratory randomized controlled trial. Ophthalmologica 2016;235:34-41.
52. Gross JG, Glassman AR, Liu D, Sun JK, Antoszyk AN, Baker CW, et al. Five-year outcomes of panretinal photocoagulation vs. intravitreous ranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA Ophthalmol 2018;136:1138-48.
53. Bisht R, Mandal A, Jaiswal JK, Rupenthal ID. Nanocarrier mediated retinal drug delivery: Overcoming ocular barriers to treat posterior eye diseases. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2018;10:1-21.
54. Jiang S, Franco YL, Zhou Y, Chen J. Nanotechnology in retinal drug delivery. Int J Ophthalmol 2018;11:1038-44.
55. Duncan R, Gaspar R. Nanomedicine(s) under the microscope. Mol Pharm 2011;8:2101-41.
56. Cho K, Wang X, Nie S, Chen ZG, Shin DM. Therapeutic nanoparticles for drug delivery in cancer. Clin Cancer Res 2008;14:1310-6.
57. Koo H, Moon H, Han H, Na JH, Huh MS, Park JH, et al. The movement of self-assembled amphiphilic polymeric nanoparticles in the vitreous and retina after intravitreal injection. Biomaterials 2012;33:3485-93.
58. Nakhlband A, Barar J. Impacts of nanomedicines in ocular pharmacotherapy. Bioimpacts 2011;1:7-22.
59. El-Ansary A, Al-Daihan S, Bacha AB, Kotb M. Toxicity of novel nanosized formulations used in medicine. In: Oxidative Stress and Nanotechnology. Totowa, NJ: Humana Press; 2013. p. 47-74.
60. Heidel JD, Yu Z, Liu JY, Rele SM, Liang Y, Zeidan RK, et al. Administration in non-human primates of escalating intravenous doses of targeted nanoparticles containing ribonucleotide reductase subunit M2 siRNA. Proc Natl Acad Sci U S A 2007;104:5715-21.
61. Keck PJ, Hauser SD, Krivi G, Sanzo K, Warren T, Feder J, et al. Vascular permeability factor, an endothelial cell mitogen related to PDGF. Science 1989;246:1309-12.
62. Leung DW, Cachianes G, Kuang WJ, Goeddel DV, Ferrara N. Vascular endothelial growth factor is a secreted angiogenic mitogen. Science 1989;246:1306-9.
63. Provis JM. Development of the primate retinal vasculature. Prog Retin Eye Res 2001;20:799-821.
64. Zhang X, Liu W, Wu S, Jin J, Li W, Wang N. Calcium dobesilate for diabetic retinopathy: A systematic review and meta-analysis. Sci China Life Sci 2015;58:101-7.
65. Sander B, Thornit DN, Colmorn L, Strøm C, Girach A, Hubbard LD, et al. Progression of diabetic macular edema: Correlation with blood retinal barrier permeability, retinal thickness, and retinal vessel diameter. Invest Ophthalmol Vis Sci 2007;48:3983-7.
66. Murakami T, Felinski EA, Antonetti DA. Occludin phosphorylation and ubiquitination regulate tight junction trafficking and vascular endothelial growth factor-induced permeability. J Biol Chem 2009;284:21036-46.
67. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: Results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 2012;119:789-801.
68. Sahoo SK, Dilnawaz F, Krishnakumar S. Nanotechnology in ocular drug delivery. Drug Discov Today 2008;13:144-51.
69. Fangueiro JF. Cationic Lipid Nanomedicines for the Treatment of Diabetic Retinopathy (Doctoral Dissertation); 2016.
70. Jo DH, Kim JH, Lee TG, Kim JH. Size, surface charge, and shape determine therapeutic effects of nanoparticles on brain and retinal diseases. Nanomedicine 2015;11:1603-11.
71. Kelkar SS, Reineke TM. Theranostics: Combining imaging and therapy. Bioconjug Chem 2011;22:1879-903.
72. Chopra P, Hao J, Li SK. Sustained release micellar carrier systems for iontophoretic transport of dexamethasone across human sclera. J Control Release 2012;160:96-104.
73. Wegman-Ostrosky T, Soto-Reyes E, Vidal-Millán S, Sánchez-Corona J. The renin-angiotensin system meets the hallmarks of cancer. J Renin Angiotensin Aldosterone Syst 2015;16:227-33.
74. Vincent F, Bonnin P, Clemessy M, Contrerès JO, Lamandé N, Gasc JM, et al. Angiotensinogen delays angiogenesis and tumor growth of hepatocarcinoma in transgenic mice. Cancer Res 2009;69:2853-60.
75. Sjølie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH, et al. Retinal microaneurysm count predicts progression and regression of diabetic retinopathy. Post-hoc results from the DIRECT programme. Diabet Med 2011;28:345-51.
76. Effects of aspirin treatment on diabetic retinopathy. ETDRS report number 8. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98:757-65.
77. Esgin H, Samut HS. Topical ketorolac 0.5% for ocular pain relief during scatter laser photocoagulation with 532 nm green laser. J Ocul Pharmacol Ther 2006;22:460-4.
78. Patrício JP, Barbosa JP, Ramos RM, Antunes NF, de Melo PC. Relative cardiovascular and gastrointestinal safety of non-selective non-steroidal anti-inflammatory drugs versus cyclo-oxygenase-2 inhibitors: Implications for clinical practice. Clin Drug Investig 2013;33:167-83.
79. Friedman SM, Almukhtar TH, Baker CW, Glassman AR, Elman MJ, Bressler NM, et al. Topical nepafenec in eyes with noncentral diabetic macular edema. Retina 2015;35:944-56.
80. Bolinger MT, Antonetti DA. Moving past anti-VEGF: Novel therapies for treating diabetic retinopathy. Int J Mol Sci 2016;17. pii: E1498.
81. Zafir-Lavie I, Michaeli Y, Reiter Y. Novel antibodies as anticancer agents. Oncogene 2007;26:3714-33.
82. Yonekawa Y, Kim IK. Clinical characteristics and current treatment of age-related macular degeneration. Cold Spring Harb Perspect Med 2014;5:a017178.
83. Vadlapudi AD, Vadlapatla RK, Mitra AK. Current and emerging antivirals for the treatment of cytomegalovirus (CMV) retinitis: An update on recent patents. Recent Pat Antiinfect Drug Discov 2012;7:8-18.
84. Del Amo EM, Urtti A. Current and future ophthalmic drug delivery systems. A shift to the posterior segment. Drug Discov Today 2008;13:135-43.
85. Kim YC, Chiang B, Wu X, Prausnitz MR. Ocular delivery of macromolecules. J Control Release 2014;190:172-81.
86. Xu Q, Kambhampati SP, Kannan RM. Nanotechnology approaches for ocular drug delivery. Middle East Afr J Ophthalmol 2013;20:26-37.
87. Lavik E, Kuehn MH, Kwon YH. Novel drug delivery systems for glaucoma. Eye (Lond) 2011;25:578-86.
88. Deshpande PP, Biswas S, Torchilin VP. Current trends in the use of liposomes for tumor targeting. Nanomedicine (Lond) 2013;8:1509-28.
89. Kim TW, Lindsey JD, Aihara M, Anthony TL, Weinreb RN. Intraocular distribution of 70-kDa dextran after subconjunctival injection in mice. Invest Ophthalmol Vis Sci 2002;43:1809-16.
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How to Cite
FIROZ MV, VISHAL GUPTA N, and SANDEEP KANNA. “The CURRENT TRENDS AND TREATMENTS IN DIABETIC RETINOPATHY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 7, May 2019, pp. 27-33,
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