Diabetic macular oedema: physical, physiological and molecular factors contribute to this pathological process
Article first published online: 11 MAR 2010
© 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol
Volume 88, Issue 3, pages 279–291, May 2010
How to Cite
Ehrlich, R., Harris, A., Ciulla, T. A., Kheradiya, N., Winston, D. M. and Wirostko, B. (2010), Diabetic macular oedema: physical, physiological and molecular factors contribute to this pathological process. Acta Ophthalmologica, 88: 279–291. doi: 10.1111/j.1755-3768.2008.01501.x
- Issue published online: 27 APR 2010
- Article first published online: 11 MAR 2010
- Received on December 20th, 2007. Accepted on November 13th, 2008.
- diabetic macular oedema;
- diabetic retinopathy;
Diabetic macular oedema (DMO) is an important cause of vision loss in patients with diabetes mellitus. The underlying mechanisms of DMO, on both macrocellular and microcellular levels, are discussed in this review. The pathophysiology of DMO can be described as a process whereby hyperglycaemia leads to overlapping and inter-related pathways that play a role not only in the initial vascular events, but also in the continued tissue insult that leads to chronic DMO. On a macrocellular level, DMO is believed to be in part caused by alterations in hydrostatic pressure, oxygen tension, oncotic pressure and shear stress. Three key components of the microvascular pathways include angiogenic factor expression, inflammation and oxidative stress. These molecular mediators, acting in conjunction with macrocellular factors, which are all stimulated in part by the hyperglycaemia and hypoxia, can have a direct endothelial effect leading to hyperpermeability, disruption of vascular endothelial cell junctions, and leukostasis. The interactions, signalling events and feedback loops between the various molecules are complicated and are not completely understood. However, by attempting to understand the pathways involved in DMO, we can help guide new treatment options targeted towards specific factors or mediators.