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Surgical and Other Treatments of Diabetic Macular Edema: An Update

The breakdown of the inner and outer retinal barriers is one of the earliest changes in DR. This has been seen in patients with diabetes without retinopathy and can be demonstrated with vitreous fluorophotometry, which shows increased fluorescein concentrations in the vitreous. The principal targets of this breakdown appear to be the tight junctions of the endothelial cells. Two of the components of tight junctions, ZO-1 and occludin, have been found to have decreased levels of expression coincident with increased blood-retina barrier permeability in DR. Another target is the Müller’s cells. They have been shown to maintain the integrity of the BRB, yet are affected early on in diabetic retinopathy (DR) as evidenced by increased levels of anaerobic glycolysis and abnormalities in