In spite of the extensive research the complex pathogenesis of diabetic
retinopathy (DR) has not been fully elucidated. For many years it has been thought
that diabetic retinopathy manifests only with microangiopathic lesions, which are totally
responsible for the loss of vision in diabetic patients. In view of the current
knowledge on the microangiopathic changes in the fundus of the eye, diabetic
retinopathy is perceived as a neurodegenerative disease. Several clinical tools are
available to detect neuronal dysfunction at early stages of diabetes. Many functional
changes in the retina can be identified before vascular pathology develops, suggesting
that they result from a direct effect of diabetes on the neural retina. In the course of
diabetes there is a chronic loss of retinal neurons due to increased frequency of
apoptosis. The neuronal apoptosis begins very early in the course of diabetes. This observation has led to
suggestions that precautions against DR should be implemented immediately after diabetes is diagnosed.
Neurodegeneration cannot be reversed; therefore treatments preventing neuronal cell loss in the retina
need to be developed to protect diabetic patients. This review is an attempt to summarize what is
currently known about the mechanisms of neuronal apoptosis in the context of diabetic retinopathy and
vascular degeneration as well as about potential treatments of DR.
Keywords: Diabetic retinopathy, neurodegeneration of neurons, neuroinflammation, neuroprotection.
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