Diabetic retinopathy
Microvascular complication of diabetes. Management rests on tight glycaemic, blood pressure, and lipid control; intravitreal anti-VEGF (aflibercept, ranibizumab, brolucizumab, faricimab), laser photocoagulation, and vitrectomy as needed in clinically significant macular edema and proliferative disease. AAO 2024 PPP and DRCR Retina Network do not recommend systemic 'neuroprotectors' or non-specific 'vascular agents'.
Also known as: DR, Proliferative diabetic retinopathy, DME
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DCalcium dobesilateNot recommended · Capillary-stabilizing and venoactive agentHistorically used in non-proliferative diabetic retinopathy in Spain, Eastern Europe, and Latin America. No evidence base: the 2017 Cochrane review of calcium dobesilate in diabetic retinopathy showed no clinically meaningful effect on disease progression or visual preservation. ICO 2017 and AAO 2024 do not list it among preferred agents. Foundation therapy for diabetic retinopathy: glycemic, blood pressure, and lipid optimization; for proliferative disease and macular edema – laser photocoagulation, intravitreal anti-VEGF (ranibizumab, aflibercept, bevacizumab).
- FCortexin (bovine brain cortex polypeptides)Not recommended · Other psychostimulants and nootropics (local classification)AAO 2024 Diabetic Retinopathy PPP and DRCR Retina Network protocols recommend glycaemic, blood pressure, and lipid control; intravitreal anti-VEGF for clinically significant macular edema and proliferative disease; retinal laser photocoagulation. Cortexin and other systemic peptide agents are absent from these documents. RCTs of Cortexin with outcomes on visual acuity, retinal thickness, or progression are not available in international journals.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit