Abstract:

Diabetic retinopathy (DR) is a leading microvascular complication of diabetes mellitus and a major cause of preventable blindness in adults worldwide. It results from chronic hyperglycemia-induced damage to retinal capillaries, leading to vascular leakage, ischemia, and pathological neovascularization. This review aims to summarize the current understanding of the molecular and cellular mechanisms underlying diabetic retinopathy, highlight diagnostic and imaging advances, and discuss emerging therapeutic strategies beyond conventional laser and pharmacologic interventions. Key pathophysiologic mechanisms involve activation of the polyol pathway, accumulation of advanced glycation end-products (AGEs), protein kinase C (PKC) overactivation, and upregulation of vascular endothelial growth factor (VEGF). These processes trigger oxidative stress, inflammation, and neurovascular dysfunction. Recent innovations in imaging such as optical coherence tomography angiography (OCTA) and AI-based screening have improved early detection. Emerging therapies, including anti-VEGF agents, corticosteroid implants, and gene- or cell-based therapies, show promising outcomes. Diabetic retinopathy represents a multifactorial neurovascular disease. Early detection, optimal metabolic control, and individualized multimodal therapy are crucial to prevent irreversible vision loss. Future research should focus on precision medicine approaches integrating biomarkers, genetics, and artificial intelligence.