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Treatment of diabetic retinopathy

In popular science literature, the term “ophthalmologic complications of diabetes mellitus” is very often found, though it would be more reasonable to regard these processes as ophthalmologic symptoms of this disease.

In diabetes mellitus, deterioration of eyesight is caused by pathological processes in the retina – diabetic retinopathy. In type 1 diabetes patients with 15-20 years history of the disease, diabetic retinopathy is reported in 80-99% of cases.

Laser Vision Center offers a special program of examination and laser treatment of the retina affected by diabetes.

First of all, it is necessary to single out principal stages of the disease.

There are three consecutive stages of diabetic retinopathy: neuroproliferative, pre-proliferative, and proliferative.

The main cause of vision deterioration in neuroproliferative diabetic retinopathy is edema of the central region of the retina resulting from changes in the retinal vessels. If persistent for several years, this edema causes irreversible necrosis of the neural elements of the retina, which results in deterioration of the vision.

Research showed that traditional medications (diuretics, angioprotectors) are not effective for prevention and dissolution of the liquid accumulated in the retina. The only way of controlling this vascular problem is laser coagulation of the retina. However, even after laser coagulation improvements are reported only by the patients with early stages of edema, when elements of the retina responsible for eyesight are still unaffected. At late stages, laser treatment can only stabilize the vision. The patients who underwent laser therapy for macular edema maintain stable vision for longer period of time in comparison with those to whom it was not applied.

The most severe stage of diabetic retinopathy is proliferative phase diagnosed when the newly formed vessels (neovessels) are formed. These vessels are anomalous, both in terms of their location and their structure (their walls are thin and brittle). Neovessels cause extensive hemorrhages even when blood pressure is normal, physical straining is moderate, and diabetes is well compensated.

The next stage of the proliferative phase is formation of fibrous tissue characterized by very good contractility. This tissue binds itself to the retina and, when contracted, stretches it, which, sooner or later, results in retinal detachment. This is the mechanism of development oretinal detachmentf often found in diabetes requiring the most complicated surgical treatment, while vision-related prognosis is not always positive.

In terms of time, this scenario of the proliferative phase can take from 3-4 months to several years. As a rule, the process never stops without intervention. At this stage, visual acuity does not reflect the processes in the retina. As a rule, pathological changes occur simultaneously in both eyes.

Being anomalous by nature, the newly formed vessels develop by “their own laws”, therefore the routine medications are ineffective. Nowadays, there are only a few medications accelerating dissolution of the intraocular hemorrhages, but neither of them is effective against neovessels.

The only way of treating neovessels is extensive laser coagulation of the retina (panretinal laser coagulation) indicated in cases of formation and growth of the neovessels.

Internationally, this method of treatment has been applied for 35 years. It is recommended by the World Health Organization as the only way to reduce the risk of blindness in case of ophthalmologic complications of diabetes mellitus. Duly performed panretinal laser coagulation is effective in 59-86% of cases and allows for long-term stabilization of the vision.

Success of laser treatment is due tactics of the doctor: modern diagnostics, due application of the method of laser treatment, obligatory follow-up of the process and additional therapy if needed.

We would like to draw your attention to the fact that regular follow-up by the laser surgeon make part and parcel of success of the treatment, irrespective of the effect of the initial treatment. Frequency of prophylactic follow-up visits depends on the type of diabetes, history of illness, degree of compensation, and related complications.

Follow-up Plan:
- diabetes mellitus without changes in the fundus – annually;
- non-complicated diabetic retinopathy – every 6 months;
- risk of proliferative course – every 3 months.

We do not promise that your vision comes back, but we will do our best to preserve it.

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