Diabetic retinopathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Diabetic retinopathy is one of the types of microangiopathy that develops against the background of long-term diabetes mellitus and affects the blood vessels of the retina. This pathology is the main cause of low vision and blindness in people with diabetes.
Diabetic retinopathy usually affects both eyes, but the extent of the involvement is usually different.
Damage to the blood vessels of the retina in diabetic retinopathy
Causes and risk factors
With a long course of diabetes mellitus, dysmetabolic disorders cause damage to the blood vessels of the retina (retina of the eyes). This is manifested:
- violation of patency (occlusion) of capillaries;
- increased permeability of the vascular wall;
- the development of scar (proliferative) tissue;
- the formation of new blood microcirculatory vessels.
The main risk factors for developing diabetic retinopathy in patients with diabetes mellitus are:
- the duration of the course of diabetes mellitus;
- obesity;
- the level of hyperglycemia;
- smoking;
- arterial hypertension;
- genetic predisposition;
- chronic renal failure;
- pregnancy;
- dyslipidemia;
- puberty;
- metabolic syndrome.
Forms of the disease
Depending on the characteristics of changes in the eye day, the following types of diabetic retinopathy are distinguished:
- Non-proliferative. The permeability and fragility of the retinal vessels increase, which contributes to the formation of microaneurysms and the appearance of punctate hemorrhages, the development of retinal edema. With the development of macular edema (in the central zone of the retina), vision deteriorates.
- Preproliferative. Occlusion of arterioles occurs, which leads to progressive ischemia and hypoxia of the retina, the occurrence of venous disorders and hemorrhagic infarctions.
- Proliferative. Chronic retinal hypoxia causes the start of the process of neovascularization, that is, the formation of new blood vessels. This is accompanied by frequent vitreous hemorrhages. As a result, fibrovascular adhesions gradually develop, which can lead to tractional retinal detachment, the appearance of secondary neovascular glaucoma.
Forms of diabetic neuropathy
Symptoms
Diabetic retinopathy develops for a long time. In the initial stages, the disease is almost asymptomatic and painless. There is no subjective sensation of decreased visual acuity in the non-proliferative stage. With the development of macular edema, patients may complain of blurred vision at close range or the appearance of blurring, indistinctness of the observed objects.
Massive intraocular hemorrhage in diabetic retinopathy threatens vision loss
In the proliferative stage of the disease, veils and dark floating spots periodically appear before the eyes. Their occurrence is associated with intraocular hemorrhage. After resorption of the blood clot, these manifestations disappear on their own. With massive intraocular hemorrhage, complete loss of vision may occur.
Diagnostics
For early diagnosis of diabetic retinopathy, patients with diabetes should be seen regularly by an ophthalmologist. As screening methods for detecting changes in the retina of the eyes, the following are used:
- perimetry;
- visometry;
- biomicroscopy of the eyes using a slit lamp;
- ophthalmoscopy with preliminary medical dilation of the pupils;
- diaphanoscopy of eye structures;
- measurement of intraocular pressure (tonometry).
When the vitreous body and lens become clouded, an ultrasound examination of the eyes is performed instead of ophthalmoscopy.
Eye biomicroscopy is used to diagnose diabetic retinopathy
To assess the functions of the optic nerve and retina, electrophysiological diagnostic methods are used, in particular, electrooculography, electroretinography. If neovascular glaucoma is suspected, gonioscopy is indicated.
One of the main methods for diagnosing diabetic retinopathy is fluorescence angiography, which makes it possible to assess the characteristics of blood flow in the retinal vessels.
Treatment
Treatment of diabetic retinopathy is aimed at maximum correction of metabolic disorders in the body, normalization of blood pressure, and improvement of microcirculation.
With macular edema, intravitreal injections of corticosteroids have a good therapeutic effect.
Progressive diabetic retinopathy is the basis for laser coagulation of the retina, which can reduce the intensity of the neovascularization process, and reduce the risk of retinal detachment.
Retinal laser coagulation
For severe diabetic retinopathy complicated by retinal detachment or traction of the macula, vitrectomy is performed. In the course of surgery, the vitreous body is removed, the bleeding vessels are cauterized, the connective tissue cords are cut.
Possible complications and consequences
The progression of diabetic retinopathy leads to the following complications:
- retinal disinsertion;
- secondary glaucoma;
- significant limitation of visual fields;
- cataract;
- complete blindness.
Forecast
The prognosis of diabetic retinopathy for visual function is always serious. Severe forms of the disease, especially in combination with atherosclerosis and arterial hypertension, often cause vision disability.
Prevention
Preventive measures aimed at preventing the onset or further progression of diabetic retinopathy include:
- regular monitoring of glycemia;
- careful adherence to the scheme of insulin therapy or taking antihyperglycemic drugs;
- adherence to a diet (table number 9 according to Pevzner);
- normalization of blood pressure;
- timely laser coagulation of the retina.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
