24 Page 24-43 © MAT Journals 2019. All Rights Reserved Journal of Clinical Trials and Regulations Volume 1 Issue 2 Recent Trends in the Treatment of Diabetic Retinopathy: A Review Munaf Jiwani 1* , Priyanshi Patel 1 , Dipta Sarkar 1 , Sudarshan Patil 1 , Priyanka B. Patel 2 M. Pharm Student 1 , Assistant Professor 2 Department of Pharmaceutics, SSR College of Pharmacy, Sayli Road, Silvassa, Union Territory of Dadra and Nagar Haveli, India Email: *munafjiwani@gmail.com DOI: http://doi.org/10.5281/zenodo.3364306 Abstract Treatments for diabetic retinopathy have had incredible advances but yet it remains most probable scenario for vision loss in diabetes. This review summarises various treatments for diabetic retinopathy including various drugs in clinical trials and also covers ongoing clinical trials in India, USA and Europe with the patents obtained for the same. The advances in pharmaceutical treatments have shown promising results yet they remain more damaging and less adequate for substantially stopping vision loss. Patient compliance and post treatment complication still occur in these widely used treatments. Keywords: Clinical trials, diabetic retinopathy, patents, treatment, vitrectomy INTRODUCTION Diabetes is now recognized as a global epidemic, the incidence of retinopathy, a common micro vascular complication of diabetes is expected to rise to alarming levels. A Global meta-analysis study reported that 1 in 3 (34.6%) had any form of Diabetic Retinopathy (DR) in the US, Australia, Europe and Asia. It is also noted that 1 in 10 (10.2%) had Vision Threatening DR (VTDR) i.e., Proliferative DR (PDR) and/or Diabetic Macular Edema (DME). DR remains a leading cause of vision loss in working adult populations. In India, diabetes shows a prevalence of 8.37% out of which 18% of diabetics are likely to develop DR. DR seriously decreases the quality of life in diabetic patients, and it also brings heavy economic burden to diabetic patients and country [1]. According to the development of DR, it has two distinct phases: an early non- proliferative phase (NPDR) characterized by increased vascular permeability and intra-retinal haemorrhage; and a late proliferative phase (PDR) characterized by retinal neovascularization. During the process of NPDR, hyperglycaemia induced damage in the retina are associated with the loss of retinal capillary pericytes, thickening of the vascular layers, and breakdown of the blood retinal barrier, which will lead to retinal iscemia and hypoxia. Proliferative growth of new vessels and subsequent tractional retinal detachment will occur when NPDR proceeds to PDR, and thus it finally led to severe vision loss [2]. A number of interconnecting biochemical pathways have been proposed as potential links between hyperglycaemia and diabetic retinopathy. These include increased polyol pathway flux, increased advanced glycation end-products (AGE) formation, abnormal activation of signalling cascades such as activation of protein kinase C (PKC) pathway, increased oxidative stress, increased hexosamine pathway flux, and peripheral nerve damage. All these pathways in one way or another end in increased oxidative stress, inflammation and vascular occlusion causing up- regulation of factors such as insulin like growth factor (IGF), stromal derived factor1 (SDF-1), vascular endothelial growth factor (VEGF), angiopoietins