Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Underlying cause of diabetic retinopathy: Metabolic instability
Francesco Cappellani, Matteo Capobianco, Francesco Leonforte, Alessandro Avitabile, Federico Visalli, Marieme Khouyyi, Rosa Giglio, Leandro Inferrera, Daniele Tognetto, Fabiana D’Esposito, Caterina Gagliano, Marco Zeppieri
Francesco Cappellani, Fabiana D’Esposito, Caterina Gagliano, Department of Medicine and Surgery, University of Enna “Kore”, Enna 94100, Italy
Francesco Cappellani, Caterina Gagliano, Mediterranean Foundation, “GB Morgagni”, Catania 95125, Italy
Matteo Capobianco, Eye Clinic, Policlinico G Rodolico, University of Catania, Catania 95121, Italy
Francesco Leonforte, Department of Integrated Hygiene, and Service Activities, University Hospital Polyclinic “G Rodolico-San Marco”, Catania 95121, Italy
Alessandro Avitabile, Faculty of Medicine, University of Catania, Catania 95123, Italy
Federico Visalli, Department of Ophthalmology, University of Catania, Catania 95123, Italy
Marieme Khouyyi, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina 98121, Italy
Rosa Giglio, Leandro Inferrera, Daniele Tognetto, Marco Zeppieri, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste 34129, Italy
Fabiana D’Esposito, Imperial College Ophthalmic Research Group Unit, Imperial College, London NW1 5QH, United Kingdom
Marco Zeppieri, Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
Co-corresponding authors: Caterina Gagliano and Marco Zeppieri.
Author contributions: Zeppieri M, Capobianco M, Khouyyi M, Visalli F, Leonforte F, Avitabile A, Giglio R, Inferrera L, Tognetto D, Gagliano C, D’Esposito F, and Cappellani F wrote the outline; Zeppieri M, Capobianco M, Khouyyi M, Visalli F, Leonforte F, Avitabile A, and Cappellani F did the research and writing of the manuscript; Zeppieri M, Visalli F, Capobianco M, Khouyyi M, Leonforte F, Avitabile A, Giglio R, Inferrera L, Tognetto D, Gagliano C, D’Esposito F, and Cappellani F assisted in the writing of the draft and final paper; Zeppieri M, Gagliano C, D’Esposito F, and Cappellani F were responsible for the conception and design of the study; Zeppieri M, Capobianco M, Khouyyi M, Visalli F, Leonforte F, Inferrera L, Gagliano C, D’Esposito F, and Cappellani F contributed to the scientific editing; Zeppieri M, Visalli F, Leonforte F, Avitabile A, Giglio R, Inferrera L, Tognetto D, Gagliano C, D’Esposito F, and Cappellani F assisted in the editing, making critical revisions of the manuscript and viewing all versions of the manuscript; Gagliano C and Zeppieri M played important and indispensable roles in the experimental design, data interpretation and manuscript preparation and thus qualified both as the co-corresponding authors; and all authors provided the final approval of the article.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Marco Zeppieri, MD, PhD, Consultant, Postdoc, Department of Ophthalmology, University Hospital of Udine, p. le S. Maria della Misericordia 15, Udine 33100, Italy.
mark.zeppieri@asufc.sanita.fvg.it
Received: February 24, 2026
Revised: March 3, 2026
Accepted: March 17, 2026
Published online: April 26, 2026
Processing time: 53 Days and 14.5 Hours
