الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
DM is a universal disease that has been associated with a significant increase in incidence among all regions of the world and in all races, ages, and sexes over the last several decades.
Diabetes may cause a reversible, temporary blurring of the vision, or it can cause a severe, permanent loss of vision. Diabetes increases the risk of developing cataracts and glaucoma.
Visual loss develops secondary to complications of DR such as diabetic macular edema (DME) and ischemia, vitreous hemorrhage, and retinal detachment (RD).
Thee Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) clinical trials confirmed the strong relationship between chronic hyperglycemia and the development and progression of diabetic retinopathy, but the underlying mechanism that leads to the development of microvascular damage as a result of hyperglycemia remains unclear.
There are a number of growth factors which have been associated with the development of diabetic retinopathy, Increased levels of IGF-1 have been found in the vitreous fluid and serum of diabetic patients.
A number of studies also suggest that the action of IGF in neovascularization is controlled by vascular endothelial growth factor (VEGF) which is the most widely studied in relation to diabetic retinopathy.
VEGF promotes angiogenesis; causes breakdown of the blood-retinal barrier, stimulation of endothelial cell growth, and neovascularization; and increases vascular permeability in the ischemic retina.
DME, defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus.
Intravitreal injection of Anti-VEGF (IVI) is currently the most commonly used procedure for the treatment of diabetic macular edema. Its effectiveness, safety and success have been widely reported and have led to a significant improvement in the prognosis of diabetic macular edema and diabetic eye disease in general.
It has been postulated that intraocular injection of anti- VEGF factors can lead to systemic absorption and reduce serum VEGF levels.
In the recent years, it has been well known that the systemic use of anti-VEGF factors can cause renal damage and impair renal function.
Several studies evaluating the safety and efficacy of anti-VEGF in diabetic patients have reported renal adverse effects.
The current study tried to detect the effect of intravitreal anti-VEGFs injection on the renal functions, the study conducted on 36 eyes of 36 patients suffering from DME by monitoring their serum creatinine, Albumin creatinine ratio and estimated GFR.
We have found that there is a statistically significant results after the second and third injections but they are not clinically significant as the kidney functions of studied cases remain within normal values.
Because of the increasing use of intravitreal anti-VEGF agents, ophthalmologists and nephrologists should be aware of the potential for kidney disease related to the use of these agents.
Early recognition of anti-VEGF–induced kidney disease is crucial, We recommend surveillance protocols to include regular monitoring of blood pressure and routine tests of kidney measures (proteinuria and serum creatinine) and microangiopathic hemolytic anemia (complete blood cell count, serum haptoglobin and lactate dehydrogenase) for patients undergoing treatment with intravitreal antiVEGF agents.