Diabetic Retinopathy: An Overview on Mechanisms, Pathophysiology and Pharmacotherapy
, Noushin Tabasumma 1, Nayla Nuren Snigdha 1, Nawfal Hasan Siam 1, Rachana V. N. R. S. Panduru 3, Shofiul Azam 4, J. M. A. Hannan 1 and Yasser H. A. Abdel-Wahab 2Round 1
Reviewer 1 Report
On the whole the title of manuscript “Diabetic Retinopathy: Complications in diagnosis and pharmacotherapy” doesn’t corresponds to aim “to summarize epidemiology, risk factors, management, and pharmacological intervention of diabetic retinopathy” and to content of manuscript where is written a lot about “Mechanism of diabetic retinopathy and classification” and pathophysiology.
In Material and methods is not precise described this 10 years period for literature search: “The literature search was limited to a time scale of 10 years to accumulate all recent data.” My suggestion is that this period is from 2011 to 2020, but if this is the case in references more than 50% of the titles are from period before 2011.
There are a lot of inaccurate descriptions and explanations. For example:
“In addition, the thickening of retinal tissue and the secretion of hard exudates and vascular leakage at the core of macula can lead to another DR subtype, DME.”
Hard exudates are result of vascular leakage and long lasting DME, they are result not cause of DME.
“Initially, wide-field imaging was mainly utilized as a screening instrument in the diagnosis and management of DR.”
Wide-field fluorescein angiography is not suitable for screening, because it is invasive diagnostic examination (used contrast dye).
Further in text authors writhe “Fluorescein angiography is an invasive, expensive, and time-consuming procedure for detecting vascular changes caused by the rupture of the inner and outer blood-retinal barrier in DR.”
In my opinion authors don’t know that UWFA is a recent variant of standard fluorescein angiography.
“Regular ophthalmologic check-ups, effective hypertension and diabetes management, and carefully scheduled focal laser treatments for DME and PDR can significantly lower the risk of vision loss.”
Laser treatment for PDR is not focal, it is pan retinal photocoagulation. Etc., etc.
“Nevertheless, medications such as AGE and VEGF inhibitors, antiplatelet and antioxidant medicines, amongst others have shown potential, as well.”
In “Conclusion” It is not correct to arrange anti-VEGF medications together with other medicines with potential positive effect, because anti-VEGF’s (ranibisumab, aflibercept) are FDA and EMA approved for treatment of DME and are first line of treatment of DME in nowadays.
Whole manuscript is not well organized, undigested.
My advice to authors is to precise their work, to find accordance between title, aim and content and to invite an ophthalmologist as a consultant.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The review titled “Diabetic Retinopathy: Complications in diagnosis and pharmacotherapy” is well reported. It includes a time scale of 10 years of data mining.
The essential aspects of the review are:
- Diagrammatic synopsis of pathogenesis and pathophysiology of DR.
- Tables showing the existing therapeutic techniques for DR management, limitations, drawbacks, and Treatments.
- Importantly, the review includes several mechanisms and prospected therapeutic targets to intervein retinopathy progression.
This article will help the scientific community involved in DR field and in its research development.
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
- The title still is not clear!
- Line 75-77 “NPDR occurs due to lesions inside the retinal capillaries resulting from oedema, haemorrhage, microaneurysms of the blood vessels and/or capillary perfusion.” What you mean with capillary perfusion, this is normal condition, I cannot accept that NPDR occurs due to … capillary perfusion!
- Once again I want to underline that treatment of PDR is with PRP (panretinal photocoagulation) NOT with focal laser! For your reference please see the following article:
Wong et al. Guidelines on Diabetic Eye Care. The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings Ophthalmology Volume 125, Number 10, October 2018
“Laser PRP is considered the mainstay of treatment for PDR.”
“Where resources permit, PRP should be considered the preferred choice of treatment of severe NPDR and all stages of PDR.”
Also you can see the Original ICO Guidelines for Diabetic Eye Care Updated 2017 on:
https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/eye-institute/images/ICOPH.pdf
And find there that treatment of PDR is with PRP, and there are different approach for treatment of DME.
- And many others inaccurate sentences and misrepresentation.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
