Diabetic retinopathy and its relevance to paediatric age. An update.

Diabetic retinopathy is a frequent chronic complication of diabetes and may predict nephropathy and cardiovascular events. Development of proliferative lesions and/or macular edema indicates that a sight-threatening stage has been reached which, if left untreated, will almost inevitably evolve to blindness. Prevention of this feared outcome relies upon optimal control of blood glucose and, when hypertension is present, blood pressure. Besides, yearly screening by ophthalmoscopy and/or retinal photography should be carried out in all people with diabetes to identify those who have developed sight-threatening lesions. Though sight-threatening retinopathy is rarely reached during paediatric age, if anything because it takes many years to develop, the retina should be carefully monitored already during childhood and adolescence. 'Florid' retinopathy and diabetic papillopathy are possible specific manifestations of retinopathy in diabetic patients during their early post-pubertal years. Pre-pubertal years, though suggested by some as protecting against diabetic retinopathy, may, in fact, contribute to and even be an independent risk factor for the development of proliferative lesions later in life. Apart from controlling glycaemia and blood pressure, ongoing phase 3 trials are evaluating new possible pharmacologic approaches to the prevention and treatment of retinopathy which, to this date, relies upon the hugely effective but destructive application of laser photocoagulation.