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Nonproliferative Diabetic Retinopathy

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Clinical Strategies in the Management of Diabetic Retinopathy

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Abstract

Nonproliferative diabetic retinopathy (NPDR) is classically defined by the presence of early intraretinal microvascular findings and is currently classified into different stages of severity, according to international proposed classifications. Recently, retinal imaging using optical coherence tomography angiography and ultrawide-field angiography has widely improved the morphological analysis of NPDR.

The Early Treatment Diabetic Retinopathy Study (ETDRS) Research Group showed that very severe NPDR has an increased risk of progression to proliferative diabetic retinopathy. Nevertheless, data from well-conducted studies demonstrated that preventive treatments, such as a tight control of blood glucose level, blood pressure, and lipid serum level, could significantly delay the onset and slow the progression of NPDR. The effectiveness of the annual screening programs, including dilated fundus examinations or the new promising telemedicine strategies, has been clearly documented. Additionally, secondary interventions could also be useful in limiting the visual loss. In the past the ETDRS suggested that early scatter photocoagulation is not indicated for eyes with mild to moderate NPDR while is indicated in case of very severe NPDR or early PDR, especially in older patients with type 2 diabetes. With the advent of ultrawide-field angiography, the detection of the ischemic areas in the far periphery has been increased and led to the development of targeted retinal photocoagulation. This technique is useful in treating selectively non-perfusion areas, while sparing the still perfused ones. In addition, intravitreal injections are nowadays a powerful tool to control NPDR, especially in cases complicated by diabetic macular edema.

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Authors and Affiliations

  1. Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Francesco Bandello, Rosangela Lattanzio, Emanuela Aragona, Alessandro Marchese, Giuseppe Querques & Ilaria Zucchiatti

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  1. Francesco Bandello
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  1. Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Francesco Bandello

  2. Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Rutgers University, Newark, NJ, USA

    Marco Attilio Zarbin

  3. Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Rosangela Lattanzio

  4. Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Ilaria Zucchiatti

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Bandello, F., Lattanzio, R., Aragona, E., Marchese, A., Querques, G., Zucchiatti, I. (2019). Nonproliferative Diabetic Retinopathy. In: Bandello, F., Zarbin, M., Lattanzio, R., Zucchiatti, I. (eds) Clinical Strategies in the Management of Diabetic Retinopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-96157-6_2

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