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Diabetic Retinopathy

Diabetic Retinopathy is a severe eye disease usually among people who suffer from diabetes. It is expressed in changes in the blood vessels of the retina, and leads to blindness without necessary medical help and treatment.

Symptoms

Diabetic retinopathy do not cause any pain, and at early stages patient may not pay attention to minor vision loss. Hemorrhages that appear are causing “curtain” effect before eyes or floating dark spots, which soon disappear without a trace (Pic. 1 b). Massive hemorrhages in a vitreous body lead to fast and full vision loss. Development of edema in macula, which is responsible for reading and ability to see tiny objects, may also cause the “curtain” effect (Pic. 1 c). It is usually hard to work and read on a short distance.

Pic.1а – normal vision                              Pic.1c – macular edema                   Рис.1в - hemorrhage
                                                         in vitreous body

Prevention of blindness in case of diabetes

Most patients who suffer from diabetes for more than 10 years usually have one or another symptom of retinal disorder. Tight control of glucose blood level, following the diet, and health way of life cut down the risks, but do not guarantee that You will not have ocular complications of diabetes. This is why the best way to prevent blindness is to check the fundus of the eye regularly.

Periodicity of examinations for people with diabetes.

Time when diabetes started
First examination time
Age before 30 In 5 years
Age after 30 Age after 30
Pregnancy First term*
Results
Follow-up period
No diabetic retinopathy yearly
Non-proliferative diabetic retinopathy 4-6 months
Proliferative, non-proliferative diabetic retinopathy or diabetic macular edema Laser treatment is prescribed with periodicity between the stages of treatment from 2-3 weeks to 4-6 months
* In case of pregnancy follow-ups should be done every term even if there are no changes in the fundus of the eye.

Treatment

Since the retinal damage in diabetes is a secondary thing, systemic management of the underlying disease is extremely important – it is necessary to perform monitoring and tight control of blood glucose levels, blood pressure, and kidneys functions.

Laser treatment is done out-patiently and most widely used in cases of diabetic retinopathy and macular edema.

Main points of laser treatment:

  • Destruction of avascular (invalid) retinal parts that are the source of defective neovessels which are the source of hemorrhages in the eye cavity and macular edema;
  • Letting more oxygen come to retina directly from the vascular tract;
  • Thermal coagulation of neovessels.

If it is preproliferative or proliferative diabetic retinopathy, then laser burns are done over the entire retinal surface, except for the central parts (panretinal laser coagulation) (Pic. 2).

Neovessels are exposed to a focal laser irradiation. This surgical method is especially efficient at early stages of treatment, preventing blindness for a long-term period in 90% of cases and more. Efficiency of laser coagulation is lower if the treatment is started later.

Pic. 2 Laser burns during panretinal laser coagulation.

Central parts of retina are exposed to laser irradiation if it is a diabetic macular edema. Duration of the treatment effect depends on systemic status of a patient.

Surgical treatment (vitrectomy) is recommended when there are massive intraocular hemorrhages or uncared proliferative retinopathy. Vitrectomy is performed to remove blood debris, dim parts of vitreous body, and fibro vascular tissues from the eye. Aspiration of a vitreous body is done at maximum volume. The posterior hyaloid membrane is removed from the eye if it is possible, it is located between retina and vitreous body, and plays very important role in the development of proliferative retinopathy.

Conservative treatment.

Patient with hemophthalm is recommended to spend as much time as possible with eyes shut. This simple method helps coagulation in a bleeding vessel and sedimentation of blood elements in lower parts of the eye due to gravity. Laser treatment of diabetic retinopathy is done when optical medium of the eye becomes more transparent. Vitrectomy is performed if it doesn’t happen in one month time.

Medication therapy for diabetic retinopathy and hemophthalm is one of the most contradictory parts in modern ophthalmology. Great number of studies was performed concerning this matter, and active search for medications still continues. At the moment there is no medication proved to be efficient for diabetic retinopathy treatment.

Methods of medication therapy for diabetic retinopathy and hemophthalm are briefly mentioned, or mentioned in paragraphs concerning perspective developments, in modern foreign literature on the subject. That is why the conservative treatment of diabetic retinopathy is not performed in most countries, and is commonly treated with systematic treatment of diabetes, laser coagulation and surgical treatment of ophthalmic complications after diabetes

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