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Diabetic retinopathy
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Diabetic retinopathy

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DIABETES AND ENDOCRINE SYSTEM

Diabetes Complications

Retinopathy is the medical term for damage to the tiny blood vessels (capillaries) that nourish the retina, the tissue at the back of your eye that captures light and relays information to your brain. These blood vessels are often affected by the high blood sugar levels associated with diabetes.

Treatment

If you have mild nonproliferative diabetic retinopathy, you may not require treatment right away. However, your eye doctor will want to closely monitor your retina. Proliferative diabetic retinopathy requires prompt surgical treatment.

The two main treatments for diabetic retinopathy are photocoagulation and vitrectomy. In many cases, these treatments are effective and slow or stop the progression of the disease for some time. But they're not a cure. Because diabetes continues to affect your body, you may experience further retinal damage and vision loss at a later time.

Photocoagulation
The goal of photocoagulation, also known as laser treatment, is to stop the leakage of blood and fluid in the retina and thus slow the progression of diabetic retinopathy. The decision to use the procedure depends on the type of diabetic retinopathy you have, its severity and how well it may respond to treatment.

Your doctor may recommend photocoagulation if you have:

  • Macular edema, a swelling that involves or threatens the center of the retina

  • Severe nonproliferative diabetic retinopathy, especially if you have type 2 diabetes

  • Proliferative diabetic retinopathy

  • Neovascular glaucoma

In photocoagulation, a high-energy laser beam creates small burns in areas of the retina with abnormal blood vessels to seal any leaks. The procedure takes place in your doctor's office or in an outpatient surgical center. Before surgery your eye doctor dilates your pupil and applies anesthetic drops to numb your eye. In some cases he or she numbs your eye more completely by injecting anesthetic around and behind your eye.

First, your chin and forehead are rested in an examination device called a slit lamp. This is a microscope that uses an intense line of light (slit) to allow your doctor to clearly view portions of your eye. Then, your doctor places a medical contact lens on your cornea — the layer of clear tissue at the front of your eye — to help focus laser light onto the sections of the retina to be treated. Fluorescein angiographic photographs may serve as maps to show where the laser burns should be placed. During the procedure you may see bright flashes from the short bursts of high-energy light.

To treat macular edema, the laser is focused on spots where blood vessels are leaking near the macula. The doctor makes "spot welds" to stop the leakage. If the leaks are small, the laser is applied directly to specific points where the leaks occur (focal laser treatment). If the leakage is widespread or diffuse, laser burns are applied in a grid pattern over a broad area (grid laser treatment).

Shortly after laser treatment, you can usually return home, but you won't be able to drive, so make sure to arrange for a ride. Your vision will be blurry for about a day. Even when laser surgery is successful in sealing the leaks, new areas of leakage may appear later. For this reason you'll have follow-up visits and, if necessary, additional laser treatments.

Immediately following laser surgery to treat macular edema, small spots caused by the laser burns may appear in your visual field. The spots generally fade and disappear with time. If you had blurred vision from macular edema before surgery, you may not recover completely normal vision.

Panretinal photocoagulation
For proliferative diabetic retinopathy, doctors use a form of laser surgery called panretinal or scatter photocoagulation. With this technique the entire retina except the macula is treated with randomly placed laser burns. The treatment causes the abnormal new blood vessels to shrink and disappear. Thus it reduces the chances of a vitreous hemorrhage and traction retinal detachment. Panretinal photocoagulation is usually done in two or more sessions.

You may notice some loss of peripheral vision afterward. Panretinal photocoagulation is a trade-off. Some of your side vision is sacrificed to save as much of your central vision as possible. You may also notice difficulties with your night vision.

Vitrectomy
A vitreous hemorrhage may clear up on its own. But if the hemorrhage is massive and doesn't clear, a vitrectomy may help to restore your sight and may allow the application of needed laser treatment.

In this procedure your surgeon uses delicate instruments to remove the blood-filled vitreous. A vitreous cutter cuts the tissue and removes it, piece by piece, from your eye. The tissue that is removed is replaced with a balanced salt solution to maintain the normal shape and pressure of the eye. A light probe illuminates the inside of the eye. The surgeon performs the procedure while looking through a microscope suspended over the eye. In this way the vitreous blood is removed to re-establish clear vision.

A vitrectomy is also used to remove scar tissue when it begins to pull the retina away from the wall of the eye. This allows a detached retina to settle back and flatten out. Your eye doctor may decide not to operate on a retina detached by scar tissue if the detachment is located away from the macula and doesn't appear to be progressing.

During a vitrectomy the surgeon may also use a laser probe to perform panretinal photocoagulation. This can prevent renewed growth of abnormal blood vessels, bleeding and scar tissue formation.

Vitrectomy can be performed under local or general anesthesia. Your eye will be red, swollen and sensitive to light for some time after surgery. For a short time afterward, you'll need to wear an eye patch and apply medicated eyedrops to help the healing. Full recovery may take weeks.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/15/08 12:15 AM