Diabetic retinopathy

September 2, 2011

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Diabetes   It is one of the most common diseases, they suffer more than 5% of the world population. In diabetes patient blood sugar levels rise, which affects the state of all blood vessels in the body, as well as on vessels retinal . Retinal damage in diabetes is called diabetic retinopathy, which is the main cause of blindness and loss of efficiency.

In the development of the disease plays an important role age of the patient. If diabetes mellitus was diagnosed 30 years, the incidence of retinopathy increases: 10 years - 50% after 20 years - 75%. If the diabetes has begun after 30 years, retinopathy develops quickly and can occur in 5-7 years in 80% of cases. The disease affects both patients insulin And insulinnezavisimym type of diabetes .

Stages of diabetic retinopathy

Diabetic retinopathy consists of several stages. The initial stage is called retinopathy neeproliferativnoy And characterized by the appearance microaneurysms That dilate the arteries, point hemorrhages in the eye in the form of dark spots round shape or shtrihoobraznyh bands appearance of ischemic areas of the retina, retinal edema in the macular region, as well as increased permeability and fragility of vessel walls. In this case, through the thinning vessels in the retina gets liquid part of blood, leading to the formation of edema. If this process is involved and the central part of the retina is observed reduced vision .

It should be noted that this form of diabetes can occur at any stage of the disease, and represents the initial stage of retinopathy. If it is not treated, there is a transition to the second stage of the disease.

The second stage of retinopathy - proliferative Which is accompanied by blood circulation in the retina, which leads to a deficiency of oxygen in the retina ( anoxaemia . ischemia ). To restore the oxygen the body creates new blood vessels (a process called neovascularization ). The newly formed vessels are damaged and bleed, causing blood enters the vitreous, retinal layers. As a result, there is floating haze in his eyes against the backdrop of reduced vision.

In the later stages of retinopathy by continuing the growth of new blood vessels and scar tissue may lead to retinal detachment and Development Glaucoma .

The primary cause of diabetic retinopathy is not enough insulin That leads to the accumulation of fructose   and sorbitol Contributing to high blood pressure, thickening of the capillary walls and narrowing of the lumen.

Symptoms of diabetic retinopathy

The main symptoms of retinopathy depends on the stage of the disease. Typically, patients complain of blurred vision, appearance of floating dark opacity in the eye   (midges), and a sharp loss of vision. Importantly, the sharpness of vision depends on the level of sugar in the blood. However, in the initial stages of retinopathy of visual disorders is practically not observed, so people with diabetes should have regular eye exam   to detect the first signs of the disease.

Diagnosis of diabetic retinopathy

People suffering from diabetes should have regular eye exams, so it is possible to identify the development of ocular complications in the early stages, and start early treatment. Diabetics should be under constant supervision of not only the therapist and endocrinologist, but also an ophthalmologist.

The diagnosis of diabetic retinopathy is placed on the basis of complaints of the patient on reduced vision and fundus examination with the help of ophthalmoscope . Ophthalmoscopy reveals pathological changes fundus. For ophthalmic research include determining the level of intraocular pressure, biomicroscopy of the anterior eye.

Besides fundus photographing is performed by funduskamery That allows you to document changes in the retina of the eye, and fluorescein angiography to determine the localization of the vessel from which the liquid is released and calls macular edema . Biomicroscopy lens is carried out using a slit lamp.

Treatment of diabetic retinopathy

Retinopathy Treatment depends on the severity of the disease and consists of a number of medical procedures.

In the initial stages of the disease recommended therapeutic treatment. In this case, appointed by prolonged use of drugs that reduce capillary fragility - angioprotectors   ( Dicynonum . parmidin . predian . doksium ), As well as the supervision and maintenance of blood sugar levels. For the prevention and treatment of vascular complications of retinopathy appointed as sulodexide . It is also used Vitamin P . E . ascorbic acid And antioxidants, for example, Strix , Which includes blueberry extract and beta-carotene. This drug strengthens the vascular net, protects against free radicals and improves vision.

If the diagnosis of diabetic retinopathy shows major changes such as the formation of new blood vessels, swelling of the central area of ​​the retina, bleeding in the retina, it is necessary to promptly start the laser treatment and in advanced cases - to abdominal surgery .

In the case of the central zone of retinal edema ( macula ) And the formation of new blood vessels bleeding, requires laser coagulation of the retina . During this procedure, the laser energy is delivered directly to the damaged areas of the retina through the cornea, anterior chamber, lens and vitreous body without incisions.

The laser can also be used to cauterize retinal areas outside the central vision who experience oxygen starvation. In this case, the laser is destroyed ischemic process in the retina, resulting in new blood vessels were not formed. Also applying laser removes already formed pathological vessel that reduces edema.

Thus, the main task of laser coagulation of the retina - it prevent progression of the disease, and to achieve this is usually carried out several (on average 3-4) sessions coagulation That are performed at intervals of several days, and last for 30-40 minutes. During a session of laser coagulation may occur pain, which can be used when local anesthesia into the surrounding eye tissue.

A few months after the end of treatment appointed by carrying fluorescein angiography to determine the condition of the retina.

Cryocautery   Retinal performed if the patient observed strong changes in the fundus, a lot of fresh hemorrhage, newly formed blood vessels, and if laser photocoagulation or vitrectomy impossible.

If a patient develops non-proliferative diabetic retinopathy vitreous hemorrhage, which is not absorbed ( hemophthalmus ) Then assigned vitrectomy . It is advisable to carry out this operation in the early stages, which significantly reduces the risk of complications of diabetic retinopathy.

During vitrectomy doctor removes vitreous here and accumulated blood and replaces it with the saline solution (or silicone oil). At the same time the scars that cause tears and retinal detachment, and are cut by laser ( diatermokoagulyator ) To cauterize the bleeding vessels.

In the treatment of diseases such as diabetic retinopathy occupy a special place normalization of carbohydrate metabolism Since hyperglycemia   contributes to the progression of the disease. This occurs by the destination antidiabetic drugs . Also plays an important role and the normalization of the patient's diet.

Treatment of diabetic retinopathy should be conducted jointly by the ophthalmologist and the endocrinologist. With timely diagnosis and complex treatment has every chance to preserve vision and a full social and personal life.

Prevention of diabetic retinopathy

Prevention of retinopathy is to maintain normal blood sugar levels in diabetics, the optimal compensation of carbohydrate metabolism, blood pressure control, lipid metabolism correction. This allows you to reduce the possible complications of the eye.

Proper nutrition and regular exercise a positive influence on the general condition of patients with diabetes. It is also important to have regular checkups with a doctor-ophthalmologist. Timely prevention of diabetic retinopathy and eye disease in diabetes is very important. Since the late stages of the disease treatment is not effective. However, due to the fact that in the initial stages of retinopathy is not observed visual disturbances, patients seek help when it is already happening extensive hemorrhage and changes in the central area of ​​the retina.

Complications of diabetic retinopathy

The major complications of diabetic eye disease are traction retinal detachment , at ozniknovenie gemofalma , and secondary neovascular glaucoma Whose treatment requires surgical intervention.