Revisión del protocolo para el tratamiento de la retinopatía diabética

  1. Alicia Cristina Pareja Ríos
  2. Miguel Ángel Serrano García
  3. E. Quijada Fumero
  4. D. Marrero Saavedra
  5. Francisco Cabrera López
  6. Pedro Abreu Reyes
  7. Pedro Ignacio Cardona Guerra
  8. Miguel Ángel Reyes Rodríguez
Archivos de la Sociedad Española de Oftalmologia

ISSN: 0365-6691

Year of publication: 2009

Volume: 84

Issue: 2

Pages: 65-74

Type: Article

DOI: 10.4321/S0365-66912009000200004 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Archivos de la Sociedad Española de Oftalmologia


Cited by

  • Dimensions Cited by: 2 (12-04-2023)

SCImago Journal Rank

  • Year 2009
  • SJR Journal Impact: 0.215
  • Best Quartile: Q3
  • Area: Ophthalmology Quartile: Q3 Rank in area: 68/108


(Data updated as of 12-04-2023)
  • Total citations: 2
  • Recent citations: 0
  • Relative Citation Ratio (RCR): 0.08
  • Field Citation Ratio (FCR): 0.36


We present general guidelines to help us with the treatment of diabetic retinopathy (DR) at a time when numerous therapeutic alternatives have been developed although their role has not yet been adequately defined. This protocol is not directed at experienced retinologists but rather at general ophthalmologists who require a practical and up to date guide of a pathology as prevalent as RD. The different therapeutic options available, and their most accepted indications depending on the degree of diabetic retinopathy that patients have, are reviewed. We propose what to do in cases of mild, moderate and severe non-proliferative diabetic retinopathy as well as in cases of proliferative diabetic retinopathy (panphotocoagulation/antiangiogenic drugs/vitreorretinal surgery). The treatment of diabetic macular edema depending on its angiographic and topographic characteristics is also discussed. The importance of metabolic control of the patient is stressed (tight glycemic control, control of arterial hypertension and dyslipemia) in aiding the treatment of diabetic retinopathy. This therapeutic proposal has been discussed widely by retinologists from the four largest hospitals in the Canary Islands, and is therefore an agreed text based on recent scientific literature.

Bibliographic References

  • Verdaguer Tarradella, J. (2006). Retinopatía diabética: Tratado médico quirúrgico. MacLine. Madrid.
  • Shimura, M, Yasuda, K, Nakazawa, T, Kano, T, Ohta, S, Tamai, M. (2003). Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 110. 2386-2394
  • Arévalo, F, Alfaro, V, García, RA, Fernández, CF. (2006). Retinopatía diabética: Tratado médico quirúrgico. MacLine. Madrid.
  • Berrocal, MH. (2006). Retinopatía diabética: Tratado médico quirúrgico. MacLine. Madrid.
  • (2008). A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 115. 1447-1449
  • Cabrera López, F, Cabrera Marrero, B, Baeta Bayón, L, Jerez Olivera, E, Cardona Guerra, P. (2005). Actualización en el diagnóstico y tratamiento del edema macular diabético. Arch Soc Can Oftalmol. 16. 69-82
  • Lewis, H, Abrams, GW, Blumenkranz, MS, Campo, RV. (1992). Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 99. 753-759
  • Pendergast, SD, Hassan, TS, Williams, GA, Cox, MS, Margherio, RR, Ferrone, PJ. (2000). Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol. 130. 178-186
  • Harbour, JW, Smiddy, WE, Flynn, HW Jr, Rubsamen, PE. (1996). Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 121. 405-413
  • Gandorfer, A, Messmer, EM, Ulbig, MW, Kampik, A. (2000). Resolution of diabetic macular edema after surgical removal of the posterior hyaliod and the inner limiting membrane. Retina. 20. 126-133
  • Avic, R, Karderli, B, Avic, B, Simsek, S, Baykara, M, Kahveci, Z. (2004). Pars plana vitrectomy and removal of the internal limiting membrane in the treatment of chronic macular oedema. Graefes Arch Clin Exp Ophthalmol. 242. 845-852
  • Recchia, FM, Ruby, AJ, Recchia, CA. (2005). Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema. Am J Ophthalmol. 139. 447-454
  • David, J, Browning, CM, Powers, F, Powers, ME. (2006). Comparison of the magnitude and time course of macular thinning induced by different interventions for diabetic macular edema: implications for sequence of application. Ophthalmology. 113. 1713-1719
  • Yanyali, A, Nohutcu, AF, Horozoglu, F, Celik, E. (2005). Modified grid laser photocoagulation versus pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Am J Ophthalmol. 139. 795-801
  • Avery, RL, Pearlman, J, Pieramici, DJ, Rabena, MD, Castellarin, AA, Nasir, MA. (2006). Intravitreal bevacizumab (Avastin)in the treatment of proliferative diabetic retinopathy. Ophthalmology. 113. 1695-1705
  • Spaide, RF, Fisher, YL. (2006). Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 26. 275-278
  • Friedlander, SM, Welch, RM. (2006). Vanishing disc neovascularization following intravitreal bevacizumab (Avastin) injection. Arch Ophthalmol. 124. 1365
  • Mason, JO, Nixon, PA, White, MF. (2006). Intrvitreal injection of bevacizumab (Avastin) as adjuntive treatment of proliferative diabetic retinopathy. Am J Opthalmol. 142. 685-688
  • Nguyen, QD, Tatlipinar, S, Shah, SM, Haller, JA, Quinlan, E, Sung, J. (2006). Vascular endotelial growth factor is a critical stimulus for diabetic macular edema. Am J Ophthalmol. 142. 961-969
  • Chun, DW, Heier, JS, Topping, TM, Duker, JS, Banker, JM. (2006). A pilot study of multiple intravitreal injections of ranibizumab in partients with center involving clinically significant diabetic macular edema. Ophthalmology. 113. 1706-1712
  • (2005). A phase II randomized, double-masked, trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 112. 1747-1757
  • Thomas, ER, Wang, J, Ege, E, Madsen, R, Hainsworth, DP. (2006). Intravitreal triamcinolone acetonide concentration after subtenon injection. Am J Ophthalmol. 142. 860-861
  • Haritoglou, C, Neubauer, A, Wolf, A, Priglinger, S, Strauss, R, Gandonfer, A. (2006). Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 26. 999-1005
  • Tachi, N, Ogino, N. (1996). Vitrectomy for diffuse diabetic macular edema in cases of diabetic retinopathy. Am J Ophthalmol. 122. 258-260
  • Otani, T, Kishi, S. (2002). A cotrolled study of vitrectomy for diabetic macular edema. Am J Ophthalmol. 134. 214-219
  • Avitabile, T, Longo, A, Reibaldi, A. (2005). Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 140. 695-702