Expert Group Position Statement on the Use of Sulodexide as Adjunctive Therapy in Mild to Moderate Diabetic Retinopathy

Diabetic retinopathy – epidemiology

Diabetic retinopathy (DR) remains the leading cause of vision loss in the working age population [1]. The number of patients with diabetes mellitus is growing exponentially, and the WHO has declared the disease a 21st century epidemic. Currently, an estimated 415 million people (8.8% of the population) – or one in 11 of the world’s adults – are living with the disease. In Poland, according to the 2019 National Health Fund (NFZ) report, nearly 3 million people (9.1% of the population) have diabetes [2]. Approximately one in three people with the disease develop diabetic retinopathy. The incidence increases with the duration of the underlying disease. Factors elevating the risk of DR include metabolic decompensation of the underlying disease, abnormal lipid profile, as well as arterial hypertension. Unfortunately, some diabetic patients, despite normal parameters determined in the evaluations listed above, develop microangiopathy. Therefore, the role of partially identified genetic factors predisposing to the development of vascular complications of diabetes mellitus is being increasingly highlighted.

Diabetic retinopathy – classification

Classification of the severity of diabetic retinopathy is based primarily on the analysis of ophthalmoscopy fundus images, as well as the results of retinal optical coherence tomography and fluorescein angiography (Table I) [1].
Typical signs of non-proliferative DR include microaneurysms, intraretinal hemorrhages, hard exudates (lipid and protein deposits), cotton wool spots (axoplasmic stasis in the ganglion cell layer secondary to retinal ischemia), venous dilation and beading, and intraretinal vascular abnormalities. Hard exudates associated with DR reflect an increase in vascular permeability secondary to vascular injury. Their presence is indicative of current or prior diabetic macular edema.
In the advanced stage of DR (proliferative diabetic retinopathy, PDR), the dominant feature of the disease is neovascularization. Changes of this type arise from the presence of large ischemic retinal areas secondary to the occlusion of damaged peripheral capillaries. Depending on its location, the observed neovascularization is divided into two types: new vessels on the disc (NVD) and new vessels elsewhere (NVE). Typically, NVE develops at the junction between normally perfused and ischemic retinal regions.
Diabetic macular edema (DME) is a distinct type...


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