Diabetic Retinopathy
normal vision
hemorrhage in vitreous body
macular edema
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 if not treated properly.
Symptoms
At early stages diabetic retinopathy can develop unnoticed for changes in retina do not cause any pain, and patient might not pay attention to minor vision loss. Hemorrhages appear causing dark floating spots or "curtain" effect, which soon disappear (Pic. 1 b). Massive hemorrhages in a vitreous body lead to fast and full vision loss. Development of macular edema might also cause the "curtain" effect. It is usually hard to work and read on a short distance.
Prevention
Most patients who suffer from this disease 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 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.
| When diabetes started | First examination period |
|---|---|
| Age before 30 | In 5 years |
| Age after 30 | On diagnosis |
| 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
As affection of retina in case of diabetes has a secondary character it is very important to treat carefully and systematically the main disease – tight control of glucose blood level, blood pressure and kidneys functioning.
Laser treatment is done out-patient and most widely used in cases of diabetic retinopathy and macular edema.
Main points of laser treatment:
- Damage of avascular parts of retina that are the source of defective neovessels which cause hemorrhages in the eye or macular edema;
- More oxygen coming directly from the vascular tract to retina;
- Thermal coagulation of neovessels.
In case of preproliferative or proliferative diabetic retinopathy laser burns are done over the entire surface of retina, 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 treatment started later.
In case of diabetic macular edema central parts of retina are exposed to laser irradiation. Treatment effect duration depends on systemic status of a patient.
Surgical treatment (vitrectomy) is advised when massive intraocular hemorrhages or uncared-for 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 performed at maximum volume. If it is possible posterior hyaloid membrane, that is located between retina and vitreous body, and plays very important part in proliferative retinopathy development, is removed from the eye.
Conservative treatment. In case of hemophthalm patient is recommended to spend as much time as possible with his/her eyes shut. This simple method helps coagulation of a bleeding vessel and sedimentation of blood elements in lower parts of the eye under influence of gravitation. Laser treatment of diabetic retinopathy is done after the transparency of the optical medium of the eye rises. If it doesn’t happen during one month vitrectomy is performed.
Medicamental therapy for diabetic retinopathy and hemophthalm is one of the most contradictory part of modern ophthalmology. Great number of investigations is done concerning this matter, and active search for medications still continues. At the moment there is no medication, which is proved to be efficient for diabetic retinopathy treatment.
Methods of Medicamental 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.
