Diabetic Retinopathy

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Mild non-Proliferative Retinopathy

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Moderate non-Proliferative Retinopathy

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Severe non-Proliferative Retinopathy

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Proliferative Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is one of the sequalae of poor or longstanding diabetes   that affects eyes especially the retina. It’s caused by damage to the blood vessels and lack of oxygen light-sensitive tissue at the inner wall of the eye (retina). At first, diabetic retinopathy may not cause symptoms or only mild vision problems. Eventually, it can cause blindness. The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the poorer the control of your blood sugar, the more likely you are to develop this eye complication.

symptoms

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include:
• Spots or dark strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Impaired colour vision
• Dark or empty areas in your vision
• Vision loss
Diabetic retinopathy usually affects both eyes.

Four Stages of Diabetic Retinopathy

Stage 1: Mild non-proliferative retinopathy:

At this early stage, small areas of balloon-like swelling occur in the retina’s tiny blood vessels.

Stage 2: Moderate non-proliferative retinopathy:

As the disease progresses, some blood vessels that nourish the retina become blocked.

Stage 3: Severe non-proliferative retinopathy:

Many more blood vessels become blocked, which disrupts the blood supply that nourishes the retina. The damaged retina then signals the body to produce new blood vessels.

Stage 4: Proliferative retinopathy:

At this advanced stage, signals sent by the retina trigger the development of new blood vessels that grow (or proliferate) in the retina and the vitreous, which is a transparent gel that fills the interior of the eye. Because these new blood vessels are abnormal, they can rupture and bleed, causing haemorrhages in the retina or vitreous and thereby, loss of vision. Scar tissue can develop and can tug at the retina, causing further damage or even retinal detachment and visual loss.

treatment for Diabetic Eye Disease?

Medical treatment of diabetic eye disease is generally directed at the underlying problem – the diabetes itself. The better control a patient has of the disease, the fewer problems they will have in the long run.

Monitoring the patient’s glycosylated haemoglobin (HbA1c) is the best assessment of the overall level of blood sugar control. A medical doctor will order this blood test at least once a year. Treatment for diabetic maculopathy.

LASER

1. If there is only a small amount of fluid accumulation threatening your central vision, laser treatment is used. Surgical treatment of diabetic eye disease most commonly involves treatment of the retina with an argon laser.

2. For focal macular oedema focal/macular photocoagulation (for smaller localised areas or grid macular photocoagulation for larger areas affected) is performed. During this laser treatment, performed in an ophthalmologist’s office, a highly focused beam of laser light is used to treat the leaking blood vessels or to treat the area of retinal swelling.

3. If there is a substantial amount of fluid collection at the macula, which may not respond to laser therapy, the following may be used.

Intravitreal Drug Therapy

If there is a substantial amount of fluid collection at the macula, which may not respond to laser therapy, the following may be used.

1. Anti-vascular endothelial growth factor (anti-VEGF)
Ranibizumab (Lucentis)
Aflibercept (Eylea)
Bevacizumab (Avastin – unlicensed)

2. Steroid
OZURDEX
Iluvien
These are injected directly into the affected eye under anaesthetic cover.
Aside from the risk of infection and haemorrhage, there is a small risk of stroke with anti-VEGF and cataract /glaucoma with the use of steroid injection.

Proliferative Diabetic Retinopathy

1.Pan-retinal photocoagulation (PRP) is performed. During this treatment, the entire retina, except for the macula (the centre of the retina), is treated with laser spots to decrease the oxygen demand of the retina and remove the need for these new blood vessels to grow.

Surgical Treatment

If there is extensive growth of abnormal new blood vessels, extensive scar tissue formation, tractional retinal detachment or severe bleeding in the cavity of the eye, a vitrectomy is performed. During a vitrectomy (usually performed in an operating theatre), the vitreous (a gel-like fluid) and the blood inside the eye are removed and replaced with a clear fluid. In some of these cases, a vitrectomy combined with laser treatment and/or retinal detachment surgery is required.

Diabetic Macular Oedema (DMO):

This occurs when the damage to the blood vessels leads to accumulation of fluid at and around the centre part of the retina (the macula). This causes a central blur invision.

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