MECHANISMS OF DEVELOPMENT AND MODERN DIRECTIONS OF TREATMENT OF DIABETIC RETINOPATHY (literature review)

Abstract

Background. Despite the significant achievements in understanding the mechanisms of diabetic retinopathy (DR), the active search for new approaches and testing directions for its treatment continues today. Aim: To determine the current state of understanding of the mechanisms of development and directions of treatment of diabetic retinopathy. Materials and methods. An information search for the results of scientific research was conducted in the online databases PubMed, Web of Science, Scopus, and Google Scholar using keywords. The search depth is 10 years. The search was performed by two independent authors. 178 sources were selected for analysis, of which 53 that met the search criteria were used. Results. From a pathophysiological point of view, DR is a complex of progressive changes in the microcirculatory channel, which lead to ischemia, neovascularization, increased permeability of the hematoretinal barrier, and macular edema. At the same time, the predominantly inflammatory nature of the damage with a sluggish chronic course and damage to retinal neurons and microvascular disorders was established. The universal mechanism of DR can be considered oxidative stress, which connects all biochemical and molecular pathways induced by hyperglycemia. Important mechanisms are loss of pericytes, changes in gene expression, activation of signaling cascades Ras/Raf-1/MEK/ERK, p38-MAPK, endothelial dysfunction and recruitment of leukocytes and monocytes, activation of NF-κB, HIF-1 and VEGF pathways, activation of apoptosis and pyroptosis. Existing methods of DR treating require significant expansion with the use of targeted therapy aimed at specific pathogenetic pathways. Conclusion. The discovery of new mechanisms of DR and the search for new directions of targeted therapy is an urgent task of modern ophthalmology.