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In addition to treating the underlying disease (which is a key area in the treatment of any secondary pathology), diabetic retinopathy, especially in the middle and late stages, requires special ophthalmic care up to and including ophthalmic surgery.
Therefore, compensation of the actual diabetic symptoms, control of blood pressure, and maximum possible normalization of fat metabolism are necessary, but measures are not sufficient to preserve the retina in diabetes.
There are three main directions in the special ophthalmic treatment of diabetic retinopathy: conservative treatment, ophthalmic surgery, and extreme laser therapy.
In this regard, it should be noted that laser therapy has developed rapidly in recent decades, it is so effective and safe that today it is rightly considered a separate therapeutic strategy, intermediate between surgical and conservative methodology.
Conservative treatment of diabetic retinopathy, in turn, can be classified according to the direction of exposure. Thus, to reduce the overload on the walls of blood vessels, drugs are prescribed that normalize the rheological parameters of the blood (density, viscosity):
Aspirin and various compounds of acetylsalicylic acid; ticlopidine (especially affects the characteristics of blood plasma, reduces the proportion of fibrinogen proteins involved in thrombosis); sulodexide (also prevents the formation of blood clots, has a radioprotective effect, stimulates the regeneration of vascular wall tissue).
In some cases, peribulbar (transdermal in the lower eyelid, up to a depth of about 10 mm) injections of trophic drugs, ie retinal supply, and dietary stimulants, are prescribed.
Intravitreal (directly into the vitreous) injections of steroid hormones, for example, triamcinolone, as well as drugs that block vascular proliferation (Lucentis, Avastin, and others) may also be mentioned.
In addition, antioxidants, which are also prescribed in combination with other drugs, have prophylactic retinol- and radioprotective effects. In general, the drug combination is selected individually and determined by the specific clinical situation.
Laser treatment (retinal coagulation)
Laser coagulation is one of the most effective methods today to prevent retinal detachment, including diabetic retinopathy. The influence of a strong and narrowly directed light flow allows you to remove the neovascular vascular network, and stimulate your own blood circulation, thus reducing the severity and alleviating the effects of local ischemia.
Depending on the planned targeted laser beam navigation, there are three main coagulation techniques: panretinal (pulsating laser "injections" with a diameter of 100-400 microns and numbers up to 2000 or more are done on the retina), focal (focused on clearly localized focus) and "trained" "put in the form of separate dots.
Complications of diabetic retinopathy
Therefore, advanced retinopathy with a long course of diabetes mellitus, regardless of type, naturally leads to severe organic changes in the tissues of the eye and can result in complete blindness. The most serious complications of diabetic retinopathy that develop in the later stages include:
- Traction (mechanical separation) separation of the retina with its ruptures;
- Permanent increase in intraocular pressure according to glaucomatous type, developing as a result of neovascularization;
- Recurrent hemophthalmos (permanent extensive bleeding in the vitreous of the eye).
In short, it should be reiterated: only timely diagnosis appropriate treatment, and preventive measures taken by a highly qualified ophthalmologist can slow down and stop the destructive processes in blood vessels and retinal tissues, ensuring the long-term preservation of visual functions at the highest possible level.
In our ophthalmological center, quality diagnostics and effective treatment are available to patients from leading Moscow retinal specialists. Entrust your vision to professionals and keep it for many years.
Lifestyle (recommendations)
Diabetes mellitus significantly affects the quality of life, requiring the patient to be responsible for medical prescriptions, recommendations, and warnings. Quite strict dietary and lifestyle restrictions are inevitable.
On the other hand, many healthy people might not notice the same limitations, because proper nutrition, smoking, and alcohol withdrawal, optimal stress and rest regimen, and self-control and self-diagnosis skills are actually the basis of active longevity.
As far as the visual system is concerned, unconventional loads and overloads that do not exist in nature are constantly encountered by every modern person.
Periodic, at least once a year, preventive visits to the ophthalmologist should become a habit. If there is such a large and severe disease as diabetes mellitus, with an accompanying high statistical risk of retinopathy,
Retinopathy - is damage to the retina of the eye that develops without the presence of an inflammatory condition. The progression of the disease results in a disruption of blood circulation in the retina, which is a very severe condition.
If this critical component of the visual system is not adequately supplied with blood, it will result in dystrophy and even blindness.
Retinopathy includes a fairly large number of subtypes, which differ in symptoms, pathogenesis, and etiology. In medicine, retinopathy is divided into two major groups - primary and secondary.
The primary group includes pathologies, the etiology of which has not yet been fully studied. Secondary include retinopathy, which develops against the background of other pathologies that develop in the human body. Separate isolated retinopathy of preterm infants.
Etiology
The etiology of the primary forms of the disease is unknown. Against the background of such pathologies, secondary retinopathies develop:
- Eyeball injuries;
- Hypertensive disease;
- Diabetes;
- Systemic atherosclerosis;
- Blood diseases;
- Toxicosis of pregnant women;
- Chest injuries.
The main reason for neonatal retinopathy is poorer retinal development in the prenatal period. It is usually observed in children born obsolete (earlier than 31 weeks). The pathology begins to progress with further care in oxygen-filled incubators.
varieties
- Central serous;
- Sharp back multifocal;
- External exudative.
- Hypertensive retinopathy;
- Diabetic
- Traumatic;
- Retinopathy for blood problems;
- Postthrombotic.
Retinopathy of prematurity does not belong to these groups.
Central serous
This form of pathology is manifested by damage to the pigment epithelium in the macular area of the retina in the form of dark oval edema.
Secondary symptoms include the disappearance of the light band, which should normally surround the retina, as well as the appearance of deposits that have a gray or yellow tinge. The central serous form refers to the idiopathic type.
The symptoms of the disease are more common in the stronger sex between the ages of 18 and 40, who do not have serious pathologies but are often prone to migraines in stressful situations.
In case of progression of this form, the patient has the following symptoms:
- Narrowing the viewing angle;
- Reduced visual function;
- Microscopy - a person inadvertently underestimates the actual dimensions of certain objects;
- Appearance by cattle.
Sharp back multifocal
The pathology is manifested by the formation of flat foci that have a gray tone. They can disappear and in their place will remain in areas without pigmentation. As the pathology progresses, peripheral vascular edema, venous damage, and optic nerve edema are observed.
- Episcleritis;
- The opacity of glass;
- Scotomas.
External exudative
A characteristic feature of this form is the accumulation of bad cholesterol, bleeding, and exudates under the retinal vascular tissue. When examined with the help of special equipment, venous shundi and microaneurysms can be detected along the edges of the fundus.
It is worth noting that such pathology progresses rather slowly. Young men are more susceptible to it. But if this cannot be detected and cured in time, dangerous complications can develop glaucoma of the eye and retinal detachment.
Hypertonic form
Hypertensive retinopathy progresses on the background of impaired renal function, and arterial hypertension. Spasms of arterioles and subsequent destruction of their walls and tissues are characteristic of the disease. The severity of this form directly depends on the stage of hypertension observed in humans.
Hypertensive retinopathy occurs in 4 stages:
- Angiopathy. The processes that occur in venules and arterioles are reversible;
- Angiosclerosis. Tissue vessels become denser and lose their transparency. As a result, it leads to organic damage to the vessels of the eye;
- Retinopathy. It is characterized by the formation of pathological foci on the retina, as well as partial hemophthalmia. At this stage, the symptoms of the disease appear - scotomas and decreased visual function. If hypertension is treated at this stage, then retinopathy of the eyes will disappear completely;
- Neuroretinopathy. Nerve edema, exudation, and retinal detachment join already existing eye lesions. Without treatment, a person can lose sight.
Diabetic form
This type of disease progresses exclusively on the background of diabetes. The pathological process takes place in three stages:
- Background retinopathy. The retinal veins dilate slightly, and microaneurysms form on the walls of the capillaries. Visually they look like red dots. At this stage, no symptoms suggestive of the disease are observed;
- Pre proliferative. It is characterized by the formation of several small or medium hemorrhages on the retina. There is a tendency to swell. Deposits of lipid exudate from around the macula. All manifestations of the pre-proliferative form are reversible;
- Proliferative retinopathy. There are two subtypes - early and late. In the early phase, neovascularization is formed on the surface of the retina, in the late phase, the newly acquired vessels gradually grow into vitreous (the body tries to normalize blood circulation by creating new vessels).
Aneurysms also form in new veins. The number of hemorrhages increases and the vitreous deforms. Proliferative retinopathy leads to tractional retinal detachment. It is impossible to restore it, even with the help of surgical intervention. Proliferative retinopathy often affects people of working age.
Atherosclerotic
The main cause of progression is atherosclerosis. The stages of pathology development are identical to the hypertonic form of pathology. In the last stage, there is a change in the color of the optic nerve, bleeding on the capillaries, as well as exudative deposits in the veins. Lack of timely treatment can lead to optic atrophy.
Traumatic
Eye and sternum injuries play a major role in the progression of the traumatic form of the disease.
- Transudate-releasing hypoxia;
- Arteriole spasm;
- Posttraumatic bleeding, which causes the development of retinal disorders, which entails the destruction of the optic nerve;
- Retinal fogging "Berlin".
Postthrombotic
The postthrombotic form begins to progress sometime after thrombosis of the central arteries or veins that feed the retina has occurred. Thrombosis usually occurs in the background of eye injury, glaucoma, or tumors of the visual apparatus.
- Acute retinal hypoxia;
- Retina on the retina;
- Vascular occlusion. This means a decrease in visual function, all the way to complete loss of vision.
Postthrombotic form of pathology often develops in elderly patients with a history of hypertension, vascular atherosclerosis, coronary artery disease, etc.
Neonatal retinopathy
Retinopathies of premature clinicians were identified in a separate group of diseases. Often, this pathology progresses due to incomplete formation of the eye structure in the prenatal period. However, the main reason for the development of retinopathy in premature babies is breastfeeding babies in oxygen wells.
The fact is that oxygen has a strong destructive effect on the tissues of the eye, so the body tries to normalize the supply of the retina on its own, stimulating the growth of new blood vessels. The highest risk of developing retinopathy in preterm infants in babies born before 31 weeks.
Treatment of retinopathy in premature infants should be started 3 weeks after the birth of the child. Adequate and timely therapy will help preserve his vision.
It is worth noting that retinopathy in premature infants can resolve itself in the future. If this does not happen, then doctors resort to cryo retinopexy or laser coagulation. Untreated retinopathy without treatment can be complicated by myopia, glaucoma, strabismus, or retinal detachment.
Diagnostic
The sooner retinopathy of preterm newborns or any other type of pathology is discovered, the better the odds of successful treatment and preservation of vision. The typical diagnostic plan consists of the following methods:
- Ophthalmoscopy. They are used to diagnose diseases in both adult patients and preterm infants;
- Tonometry;
- Perimetry;
- Ultrasound eyes;
- Measuring retinal network potential;
- Laser retinal scanning;
- Angiography.
Treatment
The treatment of the disease depends on its type as well as the stage of development. Doctors resort to the use of both conservative and surgical techniques. The method is chosen by the ophthalmologist based on the results of the examination, as well as based on the general condition of the patient.
Conservative treatment consists of using drops that contain vitamins and hormones. Surgical methods of treatment include cryosurgical coagulation, laser coagulation, and vitrectomy.
Treating retinopathy of premature age has its nuances. The pathology can disappear on its own, so the child is under the constant supervision of a pediatrician. If this does not happen, resort to surgical techniques. They provide the possibility of the complete elimination of retinopathy in premature children.
Other methods of treating the disease:
- Oxygen biotherapy;
- Vitreoretinal surgery.
Retinal retinopathy
With retinopathy, the pathological process affects the retinal vessels, leading to impaired blood flow through them. As a result, the retina undergoes dystrophy and the optic nerve undergoes atrophy.
This disease often leads to blindness. The course of retinopathy is usually painless, but with this disease, scotomas appear before the eyes in the form of spots, and veils.
There is also a progressive decline in visual function. To diagnose retinopathy, it is necessary to perform an examination by a specialist in ophthalmology, neurology, endocrinology, and cardiology.
You should also study the boundaries of the visual field, and visual acuity, perform biomicroscopy, ophthalmoscopy, fluorescent angiography of the fundus vessels, ultrasound of the eyeball, and EFI. In the case of retinopathy, concomitant systemic pathologies need to be compensated. Anticoagulants, vitamins, vasodilators,
The term retinopathy refers to an ophthalmic disease of various origins, in which changes occur in the retina. In this case, primary retinopathy is not the result of inflammatory processes or other diseases.
Primary retinopathies can be divided into acute posterior multifocal, central serous, and external exudative forms. Secondary retinopathy combines hypertonic, diabetic, and traumatic, caused by blood diseases.
Retinopathy, which occurs in premature babies, is taken in a separate form. In this case, the disease is of interest to both ophthalmologists and pediatricians.
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