Navegando por Palavras-chave "diabetic retinopathy"
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- ItemSomente MetadadadosAerobic bacterial conjunctival flora in diabetic patients(Lippincott Williams & Wilkins, 2004-03-01) Martins, E. N.; Alvarenga, L. S.; Hofling-Lima, A. L.; Freitas, D.; Zorat-Yu, M. C.; Farah, M. E.; Mannis, M. J.; Univ Calif Davis; Universidade Federal de São Paulo (UNIFESP)Objective: To study the aerobic conjunctival flora of diabetic patients and its relation to the presence and level of diabetic retinopathy and the duration of the disease.Methods: one hundred three patients from the diabetic retinopathy screening program of the Federal University of São Paulo with no evidence of ocular surface disease were included. the diabetic patient cohort was compared with 60 nondiabetic subjects. All patients underwent slit-lamp evaluation, conjunctival scrapings, and indirect ophthalmoscopy.Results: the frequency of positive conjunctival cultures was significantly higher in the diabetic group (94.18%) than in the nondiabetic group (73.33%). Among diabetic patients, a significantly higher frequency of positive cultures was detected in those with diabetic retinopathy than in those without retinopathy. Neither the duration of the diabetes nor the hypoglycemic therapy correlated with the culture results. Coagulase-negative Staphylococcus was the most common microorganism isolated, and its identification was more frequent in patients with retinopathy than in those without diabetic retinopathy.Conclusion: Diabetic patients have a significantly higher number of positive conjunctival cultures. the presence of diabetic retinopathy was correlated with an increase in positive cultures and a higher proportion of coagulase-negative Staphylococcus.
- ItemSomente MetadadadosAn automatic, intercapillary area based algorithm for quantifying diabetes related capillary dropout using OPTICAL COHERENCE TOMOGRAPHY angiography(Lippincott Williams & Wilkins, 2016) Schottenhamml, Julia; Moult, Eric M.; Ploner, Stefan; Lee, Byungkun; Novais, Eduardo Amorim [UNIFESP]; Cole, Emily; Dang, Sabin; Lu, Chen D.; Husvogt, Lennart; Waheed, Nadia K.; Duker, Jay S.; Hornegger, Joachim; Fujimoto, James G.Purpose: To develop a robust, sensitive, and fully automatic algorithm to quantify diabetes-related capillary dropout using optical coherence tomography (OCT) angiography (OCTA). Methods: A 1,050-nm wavelength, 400 kHz A-scan rate swept-source optical coherence tomography prototype was used to perform volumetric optical coherence tomography angiography imaging over 3 mm x 3 mm fields in normal controls (n = 5), patients with diabetes without diabetic retinopathy (DR) (n = 7), patients with nonproliferative diabetic retinopathy (NPDR) (n = 9), and patients with proliferative diabetic retinopathy (PDR) (n = 5)
- ItemSomente MetadadadosCHOROIDAL IMAGING USING SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY(Lippincott Williams & Wilkins, 2012-05-01) Regatieri, Caio V. [UNIFESP]; Branchini, Lauren; Fujimoto, James G.; Duker, Jay S.; Tufts Univ New England Med Ctr; Universidade Federal de São Paulo (UNIFESP); Boston Univ; MITBackground: A structurally and functionally normal choroidal vasculature is essential for retinal function. Therefore, a precise clinical understanding of choroidal morphology should be important for understanding many retinal and choroidal diseases.Methods: PUBMED (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed) was used for most of the literature search for this article. the criterion for inclusion of an article in the references for this review was that it included materials about both the clinical and the basic properties of choroidal imaging using spectral-domain optical coherence tomography.Results: Recent reports show successful examination and accurate measurement of choroidal thickness in normal and pathologic states using spectral-domain optical coherence tomography systems. This review focuses on the principles of the new technology that make choroidal imaging using optical coherence tomography possible and on the changes that subsequently have been documented to occur in the choroid in various diseases. Additionally, it outlines future directions in choroidal imaging.Conclusion: Optical coherence tomography is now proven to be an effective non-invasive tool to evaluate the choroid and to detect choroidal changes in pathologic states. Additionally, choroidal evaluation using optical coherence tomography can be used as a parameter for diagnosis and follow-up. RETINA 32: 865-876, 2012
- ItemSomente MetadadadosCHOROIDAL THICKNESS in PATIENTS WITH DIABETIC RETINOPATHY ANALYZED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY(Lippincott Williams & Wilkins, 2012-03-01) Regatieri, Caio V. [UNIFESP]; Branchini, Lauren; Carmody, Jill; Fujimoto, James G.; Duker, Jay S.; Tufts Med Ctr; Universidade Federal de São Paulo (UNIFESP); Boston Univ; MITPurpose: This study was designed to examine choroidal thickness in patients with diabetes using spectral-domain optical coherence tomography.Methods: Forty-nine patients (49 eyes) with diabetes and 24 age-matched normal subjects underwent high-definition raster scanning using spectral-domain optical coherence tomography with frame enhancement software. Patients with diabetes were classified into 3 groups: 11 patients with mild or moderate nonproliferative diabetic retinopathy and no macular edema, 18 patients with nonproliferative diabetic retinopathy and diabetic macular edema, and 20 patients with treated proliferative diabetic retinopathy and no diabetic macular edema (treated proliferative diabetic retinopathy). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-mu m intervals up to 2,500 mu m temporal and nasal to the fovea.Results: Reliable measurements of choroidal thickness were obtainable in 75.3% of eyes examined. Mean choroidal thickness showed a pattern of thinnest choroid nasally, thickening in the subfoveal region, and thinning again temporally in normal subjects and patients with diabetes. Mean subfoveal choroidal thickness was thinner in patients with diabetic macular edema (63.3 mu m, 27.2%, P < 0.05) or treated proliferative diabetic retinopathy (69.6 mu m, 30.0%, P < 0.01), compared with normal subjects. There was no difference between nonproliferative diabetic retinopathy and normal subjects.Conclusion: Choroidal thickness is altered in diabetes and may be related to the severity of retinopathy. Presence of diabetic macular edema is associated with a significant decrease in the choroidal thickness. RETINA 32: 563-568, 2012
- ItemAcesso aberto (Open Access)Comparison of full-field electroretinogram in diabetic and non diabetic dogs with cataracts(Colégio Brasileiro de Patologia Animal - CBPAEmpresa Brasileira de Pesquisa Agropecuária (EMBRAPA), 2010-12-01) Safatle, Angélica de Mendonça Vaz; Hvenegaard, Ana Paula; Otsuki, Denise; Martins, Terezinha Luiza; Kahvegian, Márcia; Berezovsky, Adriana [UNIFESP]; Salomão, Solange Rios [UNIFESP]; Barros, Paulo Sergio de Moraes; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Being the commonest ocular disorder, dense cataracts disable fundoscopic examination and the diagnosis of retinal disorders, which dogs may be predisposed. The aim of this study was to compare the electroretinographic responses recorded according to the International Society for Clinical Electrophysiology of Vision human protocol to evaluate retinal function of diabetic and non diabetic dogs, both presenting mature or hypermature cataracts. Full-field electroretinogram was recorded from 66 dogs, with ages varying from 6 to 15 years old allocated into two groups: (1) CG, non diabetic cataractous dogs, and (2) DG, diabetic cataractous dogs. Mean peak-to-peak amplitude (microvolts) and b-wave implicit time (milliseconds) were determined for each of the five standard full-field ERG responses (rod response, maximal response, oscillatory potentials, single-flash cone response and 30 Hz flicker). Comparing CG to DG, ERGs recorded from diabetic dogs presented lower amplitude and prolonged b-wave implicit time in all ERG responses. Prolonged b-wave implicit time was statistically significant (p< 0.05) at 30 Hz flicker (24.0 ms versus 22.4 ms). These data suggests full-field ERG is capable to record sensible alterations, such as flicker's implicit time, being useful to investigate retinal dysfunction in diabetic dogs.
- ItemSomente MetadadadosEmerging pharmacotherapies for diabetic macular edema(Informa Healthcare, 2007-11-01) Furlani, Bruno A.; Meyer, Carsten H.; Rodrigues, Eduardo B.; Maia, Mauricio; Farah, Michel E. [UNIFESP]; Penha, Fernando M.; Holz, Frank G.; Univ Bonn; Universidade Federal de São Paulo (UNIFESP)Diabetic macular edema (DME) is the most frequent cause of severe vision impairment in patients with non-proliferative diabetic retinopathy. Even though patients should achieve optimal glycemic control, normalization of blood pressure and serum lipids, as well as improvement of cardiac and renal status, these measures alone will not prevent every patient from developing visual loss caused by DME. the goal of local treatment for DME is vision improvement, usually achieved after reducing leakage on fluorescein angiography (FA) and retinal thickness on optical coherence tomography (OCT). Laser photocoagulation is still the standard treatment for clinically significant DME. However, laser photocoagulation rarely provides major visual improvement, especially in patients with diffuse DME. Thus, a therapeutic intervention that restores visual acuity impaired by DME more often remains a significant unmet medical need. This review aims to present the most important emerging drug technologies for therapy of DME at present, including corticosteroids, vascular endothelial growth factor inhibitors, protein kinase C inhibitors, small interfering RNA, hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors and non-hormonal anti-inflammatory agents. Recent progress in this field suggests that local management of DME may change rapidly in the near future. Novel emerging drugs should enable better anatomical and functional outcomes for therapy of this sight-threatening disease.
- ItemAcesso aberto (Open Access)Ensaio clínico randomizado multicêntrico para avaliar a eficácia de injeções intravítreas de bevacizumabe, triancinolona ou de sua combinação no tratamento do edema macular diabético(Universidade Federal de São Paulo (UNIFESP), 2015-07-31) Oliveira Neto, Hermelino Lopes de [UNIFESP]; Mattos Junior, Rubens Belfort [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In diabetic patients, it is estimated that the risk of blindness is twenty times higher than the normal population and approximately 19% of blindness in the world are caused by diabetes mellitus (DM). In Brazil, diabetic retinopathy (DR), a specific microvascular complication, is among the leading causes of irreversible blindness, affecting 7.6% of the population according to the Ministry of Health, and this disease accounts for 4.6% of severe visual impairments. The diabetic macular edema (EMD) is the primary mechanism for vision lossin patients with non-proliferative DR. It arises due to secondary formation of micro aneurysms, changes in the blood-retinal barrier, increasedinflammation and angigenic factors that promote increase in thevascular permeability abd consequent leakage of fluid and lipids to the retina. The EMD treatment includes laser photocoagulation, intravitreal injection of anti-angiogenic drugs or steroids.The aim of this study was to evaluate and compare the efficacy and adverse effects of intravitreous injections of bevacizumab, triancinolone or their combination in the treatment of clinically significant diabetic macular edema through tests of visual acuity and IOP measurements and central macular thickness. This study included142 patients with diabetic retinopathy and clinically significant macular edema from eight cities. It is a randomized, multicenter and masked study. Patients underwent ophthalmologic examination and optical coherence tomography (OCT). Afterwards they were divided into three treatment groups: (1) Bevacizumab-1.25mg /0.05ml; (2) triamcinolone-4mg /0.1ml; (3) Bevacizumab+triancinolone. The obtained average age was 58.8 years for the BEVACIZUMABE group, 57.1 years for the TRIANCINOLONE group and 61years for BEVACIZUMABE+TRIANCINOLONE group(p =0.716). We observed statistically significant improvement in visual acuity (>4lines) in all groups, comparing the results of week 24 with the baseline visit. At week 24 there was no significant difference in the visual acuity between the 3 groups (p =0.436). It was observed reduction in macular thickness in all thegroups (BEVACIZUMABE=103?m, TRIANCINOLONE=160 micrometres BEVACIZUMABE TRIANCINOLONE+=125um), and the TRIANCINOLONE group showed significantly less thick(247 microns) than the bevacizumab group (287 microns). In all groups, there was an IOP increase, and the TRIANCINOLONE group had higher mean value of IOP throughout the study period (18 mmHg) .The average number of injections was higher in the BEVACIZUMABE group (3.2 injections), followed by BEVACIZUMABE+TRIAMCINOLONE (2.4 injections) and TRIANCINOLONA (2.1injections) group.In this investigation no severe adverse event was observed. At the end of the study, there was no significant difference between the groups regarding the visual acuity, intraocular pressure and central macular thickness.
- ItemSomente MetadadadosImpact of Insulin Treatment in Diabetic Macular Edema Therapy in Type 2 Diabetes(Elsevier B.V., 2015-02-01) Matsuda, Simone [UNIFESP]; Tam, Tiffany; Singh, Rishi P.; Kaiser, Peter K.; Petkovsek, Daniel; Zanella, Maria Teresa [UNIFESP]; Ehlers, Justis P.; Cleveland Clin Fdn; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in people with type 2 diabetes.Methods: A retrospective consecutive case series of 95 patients with type 2 diabetes and DME who were treated with anti-VEGF therapy. We examined 2 cohorts: patients taking only oral antidiabetic agents and patients on insulin therapy. the main outcome measures were change in visual acuity and change in central subfield macular thickness measured by spectral-domain optical coherence tomography. the additional variables analyzed included glycated hemoglobin (A1C), creatinine, blood pressure and body mass index and their correlations with clinical findings.Results: Both groups had a statistically significant improvement in visual acuity (oral antidiabetic agents group: 20/61 to 20/49, p=0.003; insulin therapy group: 20/76 to 20/56, p=0.005). There was no difference between groups at initial or 12-month examination (p=0.239 and p=0.489, respectively). From an anatomic standpoint, central subfield macular thickness also improved significantly in both groups: from 454.7 mu m to 354.9 mu m (p<0.001) in the oral antidiabetic agents group and from 471.5 mu m to 368.4 mu m (p<0.001) in the insulin therapy group. Again, there was no significant difference between groups at initial or 12-month follow-up examinations (p=0.586 and p=0.591, respectively). Mean A1C levels remained relatively stable during the follow up in both groups.Conclusion: Anti-VEGF therapy is a useful treatment for DME. This study Suggests that chronic insulin therapy, compared with oral antidiabetic agents, does not modify the anatomic or functional effectiveness of DME treatment. (C) 2015 Canadian Diabetes Association
- ItemSomente MetadadadosThe impact of pulse duration and burn grade on size of retinal photocoagulation lesion: implications for pattern density(Lippincott Williams & Wilkins, 2011-09-01) Palanker, Daniel; Lavinsky, Daniel [UNIFESP]; Blumenkranz, Mark Scott; Marcellino, George; Stanford Univ; Universidade Federal de São Paulo (UNIFESP); OptiMedica CorpPurpose: Shorter pulses used in pattern scanning photocoagulation (10-20 milliseconds [ms]) tend to produce lighter and smaller lesions than the Early Treatment Diabetic Retinopathy Study standard 100-ms exposures. Smaller lesions result in fewer complications but may potentially reduce clinical efficacy. It is worthwhile to reevaluate existing standards for the number and size of lesions needed.Methods: The width of the coagulated zone in patients undergoing retinal photocoagulation was measured using optical coherence tomography. Lesions of moderate, light, and barely visible clinical grades were compared for 100, 200, and 400 mu m spot sizes and pulse durations of 20 ms and 100 ms.Results: To maintain the same total area as in 1,000 standard burns (100 ms, moderate) with a 400-mu m beam, a larger number of 20-ms lesions are required: 1,464, 1,979, and 3,520 for moderate, light, and barely visible grades, respectively. Because of stronger relative effect of heat diffusion with a smaller beam, with 200 mu m this ratio increases: 1,932, 2,783, and 5,017 lesions of 20 ms with moderate, light, and barely visible grades correspond to the area of 1,000 standard burns.Conclusion: A simple formula is derived for calculation of the required spot spacing in the laser pattern for panretinal photocoagulation with various laser parameters to maintain the same total coagulated area. RETINA 31: 1664-1669, 2011
- ItemSomente MetadadadosIntravitreal bevacizumab (avastin) for proliferative diabetic retinopathy: 6-months follow-up(Nature Publishing Group, 2009-01-01) Arévalo, J. F.; Wu, L.; Sanchez, J. G.; Maia, M. [UNIFESP]; Saravia, M. J.; Fernandez, C. F.; Evans, T.; Ctr Caracas; Inst Cirugia Ocular; Universidade Federal de São Paulo (UNIFESP); Hosp Univ Austral; OftalmolaserAims To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR).Methods Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 or 2.5mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits.Results Forty-four eyes of 33 patients with PDR and a mean age of 57.2-years (range: 23 82 years) participated in the study. Thirty-three eyes (75%) had previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). BCVA and OCT demonstrated improvement (P<0.0001). Three eyes without previous PRP ('naive' eyes) and with vitreous haemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous haemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed.Conclusions Intravitreal bevacizumab resulted in marked regression of RN in patients with PDR and previous PRP, and rapid resolution of vitreous haemorrhage in three naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 or 2.5mg in patients with PDR do not reveal any safety concerns.
- ItemSomente MetadadadosINTRAVITREAL BEVACIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY Results From the Pan-American Collaborative Retina Study Group (PACORES) at 24 Months of Follow-up(Lippincott Williams & Wilkins, 2017) Arevalo, J. Fernando; Lasave, Andres F.; Wu, Lihteh; Maia, Mauricio [UNIFESP]; Diaz-Llopis, Manuel; Alezzandrini, Arturo A.; Brito, MiguelPurpose: To evaluate the effects of intravitreal bevacizumab (IVB) on retinal neo-vascularization in patients with proliferative diabetic retinopathy (PDR). Methods: Retrospective multicenter interventional case series. A chart review was performed of 81 consecutive patients (97 eyes) with retinal neovascularization due to PDR, who received at least 1 IVB injection. Results: The mean age of the patients was 55.6 +/- 11.6 years. The mean number of IVB injections was 4 +/- 2.5 injections (range, 1-8 injections) per eye. The mean interval between IVB applications was 3 +/- 7 months. The mean duration of follow-up was 29.6 +/- 2 months (range, 24-30 months). Best-corrected visual acuity and optical coherence tomography improved statistically significantly (P < 0.0001, both comparisons). Three eyes without previous panretinal photocoagulation ("naive" eyes) and with vitreous hemorrhage did not require vitreoretinal surgery. Five (5.2%) eyes with PDR progressed to tractional retinal detachment requiring vitrectomy. No systemic adverse events were noted. Conclusion: Intravitreal bevacizumab resulted in marked regression of retinal neovascularization in patients with PDR and previous panretinal photocoagulation. Intravitreal bevacizumab in naive eyes resulted in control or regression of 42.1% of eyes without adjunctive laser or vitrectomy during 24 months of follow-up. There were no safety concerns during the 2 years of follow-up of IVB for PDR.
- ItemSomente MetadadadosINTRAVITREAL INJECTIONS OF ZIV-AFLIBERCEPT FOR DIABETIC MACULAR EDEMA: A Pilot Study(Lippincott Williams & Wilkins, 2016) de Andrade, Gabriel Costa [UNIFESP]; de Oliveira Dias, Joao Rafael [UNIFESP]; Maia, Andre [UNIFESP]; Farah, Michel Eid [UNIFESP]; Meyer, Carsten H. [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]Purpose:Diabetic macular edema is the leading cause of blindness in young adults in developed countries. Beyond metabolic control, several therapies have been studied such as laser treatment and intravitreal injections of corticosteroids or anti-vascular endothelial growth factor drugs. In terms of public health the long-term treatment with the current available drugs is very expensive and new therapies with the same or better effect should be investigated. This study sought to evaluate the efficacy and safety of intravitreal injections of ziv-aflibercept for the treatment of diabetic macular edema.Methods:Seven consecutive patients with diabetic macular edema were enrolled. A complete examination, including full-field electroretinography, visual acuity, central retinal thickness, and evaluation of systemic and ocular complications, was performed before and at 24 weeks after intravitreal injections of ziv-aflibercept. The seven patients were submitted to six consecutive intravitreal injections of ziv-aflibercept with a 4-week interval.Results:No significant differences were found in the amplitude or implicit time of any electroretinography component after intravitreal injections of ziv-aflibercept, and no systemic or ocular complication was observed. The improvement of visual acuity was significant at 24 weeks (P < 0.05). The central retinal thickness significantly decreased during the course of 24 weeks.Conclusion:Intravitreal injections of ziv-aflibercept seem to be a safe and effective treatment option for diabetic macular edema.
- ItemSomente MetadadadosNovel Vitreous Modulators for Pharmacologic Vitreolysis in the Treatment of Diabetic Retinopathy(Bentham Science Publ Ltd, 2011-03-01) Costa, Elaine de Paula Fiod [UNIFESP]; Rodrigues, Eduardo Buchele [UNIFESP]; Farah, Michel Eid [UNIFESP]; Sebag, Jerry; Meyer, Carsten H. [UNIFESP]; Univ Bonn; Universidade Federal de São Paulo (UNIFESP); VMR Inst; Univ So CalifVitreous constitutes about 80% of the volume of the human eye. It is an extended extracellular matrix that is composed of collagen, hyaluronan, and other extracellular matrix molecules, but mostly water. In both health as well as disease, especially diabetic retinopathy (DR), special attention should be drawn to the posterior vitreous cortex and its relation to the retinal surface. The important role of vitreous in the pathogenesis of proliferative DR has already been demonstrated by several experimental and clinical studies. Thus, vitreoretinal separation by pharmacologic vitreolysis and/or removal by surgical means are appropriate approaches to interrupt the pathogenic contribution of vitreous and prevent progression of diabetic retinopathy to more advanced stages. This review describes various aspects of the molecular morphology and structural anatomy of vitreous and the vitreoretinal interface, as well as the role of vitreous in the pathophysiology of DR. Lastly, this treatise provides a comprehensive analysis of novel vitreous modulators for pharmacologic vitreolysis in the treatment of DR. Microplasmin is currently the most promising approach to treat vitreoretinal traction by pharmacologic vitreolysis.
- ItemAcesso aberto (Open Access)Statins and Fibrates for Diabetic Retinopathy: Protocol for a Systematic Review(Jmir Publications, Inc, 2017) Mozetic, Vania [UNIFESP]; Freitas, Carolina Gomes [UNIFESP]; Riera, Rachel [UNIFESP]Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable. Objective: To assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR. Methods: In this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, "diabetic retinopathy", "statins", "fibrates", "hypolipidemic agents", and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Center on Health Sciences Information, Clinicaltrials. gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey, and we will not have language or date limits. Two review authors will independently select eligible studies and assess the risk of bias using the Cochrane Collaboration's tool. We will report structured summaries of the included studies and, if possible, conduct meta-analyses. Results: This is a protocol for a systematic review, therefore results are not available. We registered a short version of this protocol before progressing in the review and we are currently in the process of selecting the studies for inclusion. Conclusions: Intensive glucose control and lowering blood pressure and lipids are mechanisms that protect macrocirculation in diabetic patients. Both macrovascular and microvascular events in diabetic patients appear to have a common pathway, starting with endothelial injury. Thus, prevention and treatment of microvascular events may benefit from the same interventions. In the review for which we have written this protocol, we will assess whether the use of lipid-lowering oral drugs of the statin and/or fibrate groups may prevent and/or retard progression of DR, with the added benefit of preserving visual acuity.