Role of blood flow and impaired autoregulation in the pathogenesis of diabetic retinopathy

EM Kohner, V Patel, SMB Rassam - Diabetes, 1995 - go.gale.com
EM Kohner, V Patel, SMB Rassam
Diabetes, 1995go.gale.com
Several mechanisms are implicated in the pathogenesis of diabetic retinopathy. They
include biochemical, hemodynamic, and hormonal factors, aU of which have an important
role in the development of diabetic retinopathy. These factors are not independent of each
other, but rather they interact and together are responsible for the well-known lesions of
vascular occlusion, microaneurysms, hemorrhages' hard exudates, and eventually new
vessel formation. Diabetes 44: 603-607, 1995In the pathogenesis of diabetic nephropathy …
Several mechanisms are implicated in the pathogenesis of diabetic retinopathy. They include biochemical, hemodynamic, and hormonal factors, aU of which have an important role in the development of diabetic retinopathy. These factors are not independent of each other, but rather they interact and together are responsible for the well-known lesions of vascular occlusion, microaneurysms, hemorrhages' hard exudates, and eventually new vessel formation. Diabetes 44: 603-607, 1995
In the pathogenesis of diabetic nephropathy, hyperperfusion and raised intravascular pressure have been shown to be essential to the development and progression of lesions (1). In retinal circidation, hyperperfusion early in the disease has been suggested (2), but it was only with the introduction of laser Doppler velocimetry (LDV) by Riva et al.(3) that it became possible to measure retinal blood flow in larger vessels accurately, reproducibly, and noninvasively. That increased blood flow may be of importance in diabetic retinopathy is suggested by conditions that are associated with its progression--poor diabetes control, hypertension, pregnancy, and autonomic neuropathy--all of which are characterized by increased blood flow. Other conditions, such as raised intraocular pressure, good diabetes control, and moderate stenosis of the carotid artery, which reduce or normalize retinal blood flow, have a protective effect. These observations led to the hypothesis that increased retinal blood flow, made worse by impaired auto-regulation, is of pathogenic importance in the development of diabetic retinopathy.
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