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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 6109

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Special Issue Editor

Dr. Stamatios Lampsas

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2nd Department of Ophthalmology, Attikon University Hospital, Medical School, National and Kapodis-Trian University of Athens, 11528 Athens, Greece
Interests: diabetic retinopathy; endothelial properties; risk factor; retinal diseases
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Special Issue Information

Dear Colleagues,

This Special Issue aims to highlight cutting-edge research into the mechanisms, diagnostics, and therapeutics of diabetic retinopathy. We are calling for high-quality submissions that push the boundaries of diabetic retinopathy research. Diabetic retinopathy is a rapidly evolving and highly active area of research, driven by the global rise in diabetes prevalence and its status as a leading cause of vision loss. With emerging technologies and novel therapeutic targets, the race to prevent and reverse vision loss in diabetes has never been more urgent or promising. This Special Issue will bring together the latest advancements in pathophysiology, biomarkers, imaging, and treatment approaches for diabetic retinopathy.

Dr. Stamatios Lampsas
Guest Editor

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Keywords

diebetic retinopathy
retinal diseases
novel treatment strategies
progression
pathogenetic mechanisms
non-proliferative diabetic retinopathy
proliferative diabetic retinopathy

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Published Papers (5 papers)

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Research

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9 pages, 3254 KB

Open AccessArticle

Eplerenone for Central Serous Chorioretinopathy: Is There Still Room for This Treatment?

by Irini Chatziralli, Chrysa Agapitou, Stamatios Lampsas, Alexandros Chatzirallis, Alexia Risi-Koziona, Rafaela Smarlamaki, Konstantinos Pappelis, George Theodossiadis and Panagiotis Theodossiadis

Biomedicines 2026, 14(2), 368; https://doi.org/10.3390/biomedicines14020368 - 5 Feb 2026

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Abstract

Background/Objectives: The purpose of this study was to evaluate the efficacy and safety of oral eplerenone in patients with acute and chronic central serous chorioretinopathy (CSCR). Methods: In this prospective study, 43 patients with CSCR and subretinal fluid on optical coherence tomography (OCT) at baseline were divided either to oral eplerenone (n = 23) or observation (n = 20). All subjects underwent best-corrected visual acuity (BCVA) measurement, OCT, and fluorescein angiography (FA) at baseline. The changes in BCVA and subretinal resolution (SRF) were examined at 1, 6, and 12 months after the initiation of treatment. Potential adverse events were recorded. Results: At month 6, SRF resolution was observed in 78.3% and 45% of the patients in the eplerenone and control groups, respectively (p = 0.024). However, there was a recurrence of fluid in three patients in the eplerenone group and in four patients in the control group. Therefore, at month 12, 65.2% of the patients in the eplerenone group and 25% in the control group had SRF resolution (p = 0.008). There was a statistically significant improvement in BCVA at 6 months (p < 0.001) and 12 months (p < 0.001) in the eplerenone group, while in the control group, there was an improvement in BCVA at 6 months (p = 0.079) and 12 months (p = 0.259), which did not reach statistical significance. Regarding adverse events, no ocular nor systemic adverse events were reported during the follow-up period, apart from dry mouth in 7 out of 23 patients (30.4%) taking eplerenone. Conclusions: Oral eplerenone was found to be a safe and effective treatment alternative for the management of CSCR in both acute and chronic cases, providing SRF resolution in approximately 65% of patients with significant improvement in visual acuity at the 12^th month of follow-up. Full article

(This article belongs to the Special Issue Advanced Research on Diabetic Retinopathy)

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12 pages, 1150 KB

Open AccessArticle

Comparative Analysis of AI and Ophthalmologist Grading in Diabetic Retinopathy Detection

by Patricio M. Aduriz-Lorenzo, Jyothsna Rajagopal, Pradeep Walia, Gh Mustuffa Khan and Harini Indusekar

Biomedicines 2026, 14(2), 290; https://doi.org/10.3390/biomedicines14020290 - 28 Jan 2026

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Abstract

Background: Diabetic retinopathy (DR) poses a significant global health challenge that needs scalable and efficient screening pathways beyond the current limitations of teleophthalmology. This study retrospectively evaluated the diagnostic performance of an artificial intelligence (AI) DRISTi system (Version 2.1) against ophthalmologist grading for more-than-mild diabetic retinopathy (mtmDR), vision-threatening diabetic retinopathy (vtDR), and diabetic macular edema (DME). Methods: The methods involved a retrospective, observational, non-interventional validation comparing the AI DRISTi system’s output to ophthalmologist grading on 739 colour fundus images acquired using Topcon NWC 400, CrystalVue NFC 600/700, Canon CR2/CR2 AF, and Zeiss VISUCAM 500 cameras. Results: Primary outcomes included sensitivity and specificity, with statistical analyses utilizing 2 × 2 contingency tables and 95% confidence intervals. The AI system achieved an accuracy of 93.36% (sensitivity 95.03%; specificity 92.90%) for mtmDR, 98.64% (sensitivity 96.92%; specificity 99.01%) for vtDR, and 97.97% (sensitivity 92.85%; specificity 98.88%) for DME. Performance was robust and consistent across all evaluated camera types. Conclusions: In conclusion, the AI DRISTi system (Version 2.1) demonstrates strong diagnostic performance for mtmDR, vtDR, and DME, comparable to leading commercial AI systems, from fundus photographs acquired across multiple camera platforms. This system holds significant promise as an adjunctive screening tool for large-scale DR screening programs, contributing to early detection, appropriate triage, and the prevention of vision loss in at-risk populations. Full article

(This article belongs to the Special Issue Advanced Research on Diabetic Retinopathy)

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17 pages, 5404 KB

Open AccessArticle

AI-Enhanced Fluorescein Angiography Detection of Diabetes-Induced Silent Retinal Capillary Dropout and RNA-Seq Identification of Pre-Symptomatic Biomarkers

by Yiyan Peng, Huishi Toh, Dennis Clegg and Peng Jiang

Biomedicines 2025, 13(8), 1926; https://doi.org/10.3390/biomedicines13081926 - 7 Aug 2025

Viewed by 1470

Abstract

Objective: Retinal capillary dropout, characterized by acellular capillaries or “ghost vessels,” is an early pathological sign of diabetic retinopathy (DR) that remains undetectable through standard clinical imaging techniques until visible morphological changes, such as microaneurysms or hemorrhages, occur. This study aims to develop a non-destructive artificial intelligence (AI)-based method using fluorescein angiography (FA) images to detect early-stage, silent retinal capillary dropout. Methods: We utilized 94 FA images and corresponding destructive retinal capillary density measurements obtained through retinal trypsin digestion from 51 Nile rats. Early capillary dropout was defined as having an acellular capillary density of ≥18 counts per mm². A DenseNet based deep learning model was trained to classify images into early capillary dropout or normal. A Bayesian framework incorporating diabetes duration was used to enhance model predictions. RNA sequencing was conducted on retinal vasculature to identify molecular markers associated with capillary early dropout. Results: The AI-based FA imaging model demonstrated an accuracy of 80.85%, sensitivity of 84.21%, specificity of 75.68%, and an AUC of 0.86. Integration of diabetes duration into a Bayesian predictive framework further improved the model’s performance (AUC = 0.90). Transcriptomic analysis identified 43 genes significantly upregulated in retinal tissues preceding capillary dropout. Notably, inflammatory markers such as Bcl2a1, Birc5, and Il20rb were among these genes, indicating that inflammation might play a critical role in early DR pathogenesis. Conclusions: This study demonstrates that AI-enhanced FA imaging can predict silent retinal capillary dropout before conventional clinical signs of DR emerge. Combining AI predictions with diabetes duration data significantly improves diagnostic performance. The identified gene markers further highlight inflammation as a potential driver in early DR, offering novel insights and potential therapeutic targets for preventing DR progression. Full article

(This article belongs to the Special Issue Advanced Research on Diabetic Retinopathy)

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Review

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17 pages, 533 KB

Open AccessReview

The Effects of GLP-1 Receptor Agonists on Retinal Microvascular Alterations

by Stamatios Lampsas, Gerasimia-Marina Chardalia, Chrysa Agapitou, Konstantinos Papastamopoulos, Panagiotis Theodossiadis, Gerasimos Siasos, Evangelos Oikonomou, Vaia Lambadiari and Irini Chatziralli

Biomedicines 2026, 14(5), 1057; https://doi.org/10.3390/biomedicines14051057 - 7 May 2026

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Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have revolutionized the management of type 2 diabetes mellitus (T2DM) by providing robust glycemic control alongside significant cardioprotective and renoprotective benefits. This review synthesizes current mechanistic, preclinical, and clinical evidence regarding the impact of GLP-1RAs on retinal microvasculature and summarizes the current clinical evidence of GLP-1RA-induced retinal complications. GLP-1RAs exert pleiotropic effects on the retinal microvasculature, offering protection by amelioration of endothelial function, reduction in oxidative stress, inflammation, microvascular remodeling, and preservation of the blood–retinal barrier (BRB). Despite these mechanistic advantages, emerging clinical data have raised concerns regarding potential retinal adverse events associated with GLP-1RA therapy. Observational studies and pharmacovigilance analyses have suggested possible associations with non-arteritic anterior ischemic optic neuropathy (NAION), diabetic macular edema (DME), vitreous hemorrhage, retinal detachment, macular hole formation, and progression of diabetic retinopathy (DR), particularly in the context of semaglutide use. Most evidence comes from retrospective studies or secondary endpoints, limiting causal inference. Retinal complications associated with GLP-1RAs remain heterogeneous and inconclusive, requiring careful evaluation of potential risks across diverse patient populations. Future research should conduct large, randomized trials with standardized ocular endpoints, detailed imaging, and stratified analyses to clarify GLP-1RA retinal safety. Full article

(This article belongs to the Special Issue Advanced Research on Diabetic Retinopathy)

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15 pages, 798 KB

Open AccessReview

Blood Cell-Derived Inflammatory Indices in Diabetic Macular Edema: Clinical Significance and Prognostic Relevance

by Chiyu Lin, Weiqing Ye, Suyao Wu and Zijing Huang

Biomedicines 2025, 13(12), 2979; https://doi.org/10.3390/biomedicines13122979 - 4 Dec 2025

Cited by 1 | Viewed by 1258

Abstract

Diabetic macular edema (DME) is a leading cause of vision loss in patients with diabetes. While VEGF-driven vascular permeability is central to its pathogenesis, inflammation plays a complementary and pivotal role in disease progression, morphological heterogeneity, and treatment response. Readily available blood cell-derived inflammatory indices, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), monocyte-to-lymphocyte ratio (MLR), platelet-to-neutrophil ratio (PNR), and pan-immune-inflammation value (PIV), as well as platelet measures (MPV, PDW), have been investigated as low-cost markers of systemic inflammation in DME. Specifically, comparative studies have reported that an NLR ≥ 2.26 can effectively distinguish DME from non-DME with 85% sensitivity and 74% specificity. Elevated NLR is more associated with serous retinal detachment. Moreover, a baseline NLR ≤ 2.32 has been linked to a better anatomical response to treatment. This narrative review summarizes the evidence regarding these biomarkers’ diagnostic and prognostic utility and highlights their associations with OCT morphotypes and anti-VEGF responsiveness. We propose that multi-marker panels integrated with OCT features may enhance risk stratification and help personalize therapy, but emphasize that prospective, multi-center validation and harmonized thresholds are required before routine clinical application. Full article

(This article belongs to the Special Issue Advanced Research on Diabetic Retinopathy)

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