Visual impairment in diabetes mellitus. Eye diseases in diabetes mellitus and their treatment Deterioration of vision in diabetes mellitus

Vision in diabetes, unfortunately, is at high risk. There are a number of eye diseases that this endocrine disorder causes.

These include diabetic retinopathy, diabetic macular edema, cataracts and glaucoma. These conditions can cause severe visual impairment up to blindness.

Chronically high blood sugar levels affect the tiny blood vessels in the retina. The retina is one of the inner membranes of the eye, it perceives light and converts it into impulses sent through the optic nerve to the brain. Diabetic retinopathy makes the blood vessels so fragile that microbleeds constantly occur in the retina and vision. diabetes is steadily declining.

Retinal damage in diabetic retinopathy: microaneurysms, vascular edema and multiple hemorrhages

Diabetic retinopathy can progress in four stages:

• Mild non-proliferative stage. In the retina there are small areas of balloon-like swelling of blood vessels in the form of a microaneurysm. Aneurysm is a protrusion of a pathologically altered vascular wall. In these places, the greatest likelihood of rupture of the vessel and the formation of a bruise.
• Moderate non-proliferative retinopathy. As the disease progresses, the blood vessels that feed the retina may swell and lose their structure. Their blood permeability is sharply reduced. This causes certain changes in the retina, namely, swelling of the macula - the central zone responsible for the perception of fine details. On the fundus, multiple microaneurysms are determined.
• Severe non-proliferative retinopathy. Blockade of most blood vessels, which deprives the retina of the eye of diabetes, provokes the release of growth factor, which starts the process of growth of new vessels. This is also facilitated by the formation of scars, hard exudates and hemorrhages, due to which the retinal tissue does not receive sufficient nutrition.
• Proliferative diabetic retinopathy. In this advanced stage of disease progression, growth factors secreted by the retina trigger the proliferation of new blood vessels that grow along the inner surface of the retina and into the vitreous. These newly formed blood vessels are fragile, making them more prone to injury and bleeding. In places where blood accumulates, scar tissue is formed, it is quite rigid and therefore, when moving, it drags the retina along with it. So, it is separated from the choroid - traction retinal peeling.

The proliferative stage has four degrees of severity depending on the volume of connective tissue formations:

• I - fibrotic changes in one of the areas of vascular accumulations;
• II - connective tissue changes in the optic nerve head;
• III - a combination of fibrosis of vascular clusters and the optic nerve head;
• IV - gliosis is distributed throughout the fundus, and sometimes goes to the vitreous body.

Note! Vision in diabetes mellitus changes as follows - swelling of individual sections of the retina leads to compression of light-sensitive cells. As a result of their death, the patient does not develop a complete image - in places of the retina where there are no light-catching cells, parts of the picture fall out.

If there is an abundant accumulation of blood in the vitreous body, then the patient's vision function is reduced literally to distinguish between light and darkness.

This is what people with diabetic retinopathy see

The growth of fibrous tissue with subsequent separation of the retina causes permanent damage to the organs of vision, leading to blindness. As a rule, peripheral vision is lost first, then the “veil” spreads. The nature of the disease causes some return of vision after sleep or a long stay in a horizontal position. So, the retina is purely physically adjacent to the vascular wall. When the body assumes a vertical position, the shell again moves away from its place and visual impairment returns.

Multiple microhemorrhages in the retina are perceived as dark floating dots or flakes

If a detachment is suspected, immediate surgical treatment is required, since being without blood supply for a long time, the cones and rods of the retina die and then vision cannot be restored.

diabetic macular edema

This complication of diabetic retinopathy is called one of the most significant causes of reduced central vision. The macula is important for clear, straight-line vision, which is used for reading, recognizing faces. Edema occurs more often in patients with type 2 diabetes and can appear at any stage of diabetic retinopathy, but most likely already at a fairly advanced stage.

The formation of macular edema is promoted by: microthrombosis of capillaries and an increase in the permeability of retinal vessels

According to the area of ​​the lesion, edema is usually divided into focal and diffuse. Focal edema outlines a local zone of fluid leakage from microaneurysms and vessels, while diffuse edema implies hyperpermeability of the entire capillary network. As a result of edema, thickening of the retina occurs, and in some places diffuse damage causes the formation of cysts in the retina. Visual acuity falls, dystrophy of the retinal pigment epithelium may develop.

The possibility of clouding of the lens increases with increasing duration of diabetes. The cataract goes through several stages of "maturation", during which the lens thickens and increases in size: initial, immature, mature and overripe (milky).

The causes of cataracts in diabetes mellitus are an increase in sugar in the blood and chambers of the eye, impaired blood supply and nutrition of the lens, damage to nerve fibers due to endocrine disorders

True diabetic cataract is more typical for the younger age group with juvenile uncompensated diabetes. It develops rapidly, in a few days and affects both eyes at once. If you determine this process in time, then by normalizing carbohydrate metabolism, you can reverse the process. If this is not done, then further maturation of the cataract occurs and the lens acquires a uniform clouding. Nearsightedness (myopia) develops. In the iris, dystrophic processes and impaired microcirculation occur.

Glaucoma

An increase in intraocular pressure occurs when several factors are combined, but in the case of diabetes, the following points occupy the leading positions:

• deterioration of blood circulation due to diabetic retinopathy;
• hypoxia and ischemia of eye tissues due to edema and multiple hemorrhages;
• violation of the outflow of aqueous humor. Most often, at the proliferative stage of retinopathy, new vessels grow into the iris and affect the normal outflow of moisture through the anterior chamber.

The exit site of the optic nerve undergoes major pathological changes. Because intraocular pressure increased, in this area there is compression of the nerve endings, the disc even bends a little. With a prolonged course of the disease, atrophy of the optic nerve occurs and the patient loses sight. This happens gradually, first the boundaries of the blind spot expand, then the area of ​​arcuate loss of vision increases. Peripheral vision from the side of the nose gradually disappears, then it can disappear completely. This means complete atrophy of the optic nerve.

Characteristic narrowing of the visual field in glaucoma

Although some researchers believe that part of the nerve fibers is in the "sleep" stage, and with intensive treatment, vision can be restored.

Diagnostics

Depending on the severity of diabetes, it is necessary to undergo an ophthalmological examination every six months or a year. The main methods for studying the state of the eye are ophthalmoscopy (using an ophthalmoscope device, the state of the optic nerve, retina, and blood vessels is visually assessed) and fundus fluorescein angiography (FAHD).

FAHD suggests intravenous administration contrast agent. Then the doctor in the light of a special lamp examines the condition of the vessels of the eye. If there are tears and microbleeding, the fluorescent substance will help to notice them.

A specific research method - perimetry is used to determine the visual fields, this helps to establish a lesion in glaucoma or macular edema.

Retinal tomography and ultrasound biomicroscopy are used to assess the condition of the optic nerve and the thickness of the retina.

How to protect your eyesight

Vision loss in diabetes is sometimes irreversible. But early detection of the disease and comprehensive treatment can reduce the risk of blindness by 95%.

Because on early stages eye diseases do not yet have pronounced symptoms, then their examination in patients with diabetes mellitus should be carried out prophylactically regularly every 2-4 months. The usual tests that people with diabetes take are general and biochemical blood, glycated hemoglobin, C-peptide and urinalysis.

Controlling diabetes through diet, regulation of carbohydrate metabolism, and medication significantly slows the onset and reduces symptoms of retinopathy

The main task of treating the underlying disease is to maintain blood sugar levels as close to normal as possible, control high blood pressure and lower cholesterol.

Formed diabetic eye pathologies can be treated by several methods, which are used individually and in combination.

Drugs blocking vascular growth factor

In response to injury, retinal pigment epithelial cells secrete vascular growth factor to provide an additional network of vessels. Drugs that inhibit this factor are injected into the vitreous body. They suppress pathological revascularization, reducing the likelihood of bleeding and retinal edema. To date, this group of medicines includes:

• Pegaptanib (Makugen, Eyetech Pharmaceuticals/Pfizer).
• Ranibizumab (Lucentis, Genentech/Roche).
• Bevacizumab (Avastin, Genentech/Roche).

Vascular growth factor blocking drugs - a new word in the treatment of diabetic retinopathy

Most people require monthly injections of these medicines during the first six months of treatment. Thereafter, injections are needed less frequently: usually three to four during the second half year of treatment, about four during the second year of treatment, two in the third year, one in the fourth year, and none in the fifth year. This scheme has a beneficial effect on vision.

Corticosteroids

Corticosteroids injected or implanted into the eye may be used alone or in combination with other medicines or laser operations. In world practice, the Ozurdex (dexamethasone) implant is used for short-term use, and the ILUVIEN® (fluocinolone acetonide) implant is longer. Both are biodegradable and deliver a stable dose of corticosteroids to suppress retinopathy. The use of corticosteroids in the eyes increases the risk of developing cataracts and glaucoma, so intraocular pressure should be monitored during treatment with these drugs.

Focal / Reticulated Macular Laser Surgery

This method of treatment involves laser photocoagulation of damaged blood vessels, after which they stop bleeding. Such cauterization also reduces retinal edema. Usually the operation is performed once, but some patients may need a couple of sessions. The doctor can make from 1000 to 2000 cauterizations, pressing the central area. This allows you to maintain central vision.

Worldwide, laser photocoagulation is recognized as the gold standard for surgical treatment of diabetic retinopathy.

The laser is sometimes used before injections of drugs that block vascular growth factor. And sometimes only if macular edema does not decrease after treatment with anti-VEGF drugs for 6 months.

Another direction of laser surgery is “adhesion” in case of retinal detachment. It is used both as a therapeutic measure and as a preventive measure.

Also laser correction used for glaucoma. By laser iridotomy and trabeculoplasty, the outflow of intraocular fluid is restored in natural ways.

Vitrectomy

With significant hemorrhages in the vitreous body, its removal is required. This procedure is called a vitrectomy. In the process, through special holes with the help of a vitrector device, the eyes are first fed into the chamber saline solution to maintain constant pressure, then the damaged vitreous body is removed and replaced with a new one (from liquid silicone, perfluorocarbon). Also, this operation allows you to remove scars and seals. If the procedure is required for both eyes, then the second is usually treated after the first has fully recovered.

When peeling, you can resort to this operation to provide additional pressure on the retina.

Extrascleral filling

Surgical intervention, which aims to ensure a snug fit of the retina to the vascular layer. It is carried out in the zone of fresh detachment. The filling is prepared from a special sponge silicone according to the size of the peeling area, placed in the sclera and fixed there with sutures.

Retinal detachment requires immediate surgery

A variety of methods for treating eye diseases in diabetes mellitus today allows you to save or improve the eyesight of patients. The most important task of the patient himself is to carefully consider any changes in vision, and immediately undergo an examination.

Diabetic retinopathy is an eye disease characterized by damage to the retina in diabetes. Diabetes is characterized high content sugar in the patient's blood, which primarily affects the condition of the blood vessels, including the vessels of the retina.

Stages of eye diabetes

Eye disease in diabetics occurs twenty-five times more often than in the general population. Retinal damage is one of the leading causes of visual impairment in diabetes mellitus.

Eye diabetes occurs in several stages:

- The initial stage is called non-proliferative and is characterized by increased permeability of the walls of blood vessels, petechial hemorrhages in the eye and local expansion of the arteries.

- at the proliferative stagediabetic retinopathyviolation of normal blood circulation in the retina of the eye leads to a constant lack of oxygen in the retina. To create a sufficient level of oxygen, the body is forced to create more and more new vessels (the process of neovascularization). Newly formed vessels cause bleeding, while blood enters the vitreous body and layers of the retina. It is possible to slow down the development of diabetic retinopathy with the help of a special diet.

- Later stages of diabetic retinopathy are characterized by an increase in the growth of formed vessels, resulting in retinal detachment or glaucoma.

Eye Diabetes Symptoms

From the consequences of an excessive level of sugar in the blood in the human body, disruptions from the endocrine system begin to occur, and subsequently concomitant diseases develop. D diabetic retinopathy of the retina in the early stages is painless, so that the patient may not pay attention to the decrease in vision. The main symptoms of the disease are blurred vision (its clarity is directly dependent on blood sugar levels), floaters in the eye, and sudden loss of vision. Later, intraocular hemorrhages occur, accompanied by the appearance of a veil or dark spots in front of the eye, which disappear some time later. Basically, it is due to intraocular hemorrhages that retinal detachment occurs and the person becomes completely blind. Edema of the central parts of the retina also causes a sensation of a veil before the eyes. For him, a characteristic sign is the appearance of problems when reading or work that requires concentration of vision at close range.

Examination for diabetic retinopathy

Most diabetics with an experience of more than 10 years have signs of eye damage. To reduce the risk of blindness due to eye complications, blood glucose levels must be carefully monitored, a strict diet should be followed, and healthy lifestyle life. Patients with diabetes should be regularly examined by an ophthalmologist in order to diagnose concomitant eye diseases in time. In order to make a correct diagnosis, a detailed examination of the condition of the fundus is carried out using an ophthalmoscope.

Treatment of diabetic retinopathy

In clinics, the main emphasis is placed on the systemic management of the course of diabetes, and ophthalmologists solve the problem with vision by resorting to laser coagulation of the retina and surgical treatment of complications arising from diabetes. Eye treatment for diabetesincludes a whole range of proceduresdepending on the severity of the course of the disease. First of all, they include LKS - laser coagulation of the retina. Laser energy is delivered in a targeted manner to the necessary places of the retina through the cornea, lens and vitreous body. Timely and adequately performed laser coagulation of the retina is the only way to preserve vision.

Diabetic retinopathy is one of the complications of the disease, as a result of which eye damage occurs in diabetes mellitus. "Diabetes of the eye" is a vascular complication, and it is based on damage to the smallest vessels.

Diabetes mellitus is an endocrine disease characterized by high sugar content in the human body. Pathology is characterized by a long course, and the development of dangerous complications.

Vision in diabetes is significantly reduced, and irreversible transformations occur in the visual analyzer, as a result of which the structural structure of the eye is disturbed - the fundus, retina, vitreous body, optic nerves, lenses, which is extremely negative for the organ of vision.

It is necessary to consider what eye diseases occur in type 2 diabetes? How to maintain vision and protect your eyes? What is eye surgery and how to restore vision?

First symptoms

Changing the organ of vision in diabetes is a slow process, and at first a person does not notice any significant changes in his visual perception. As a rule, patients' vision is still sharp, there are no pain in the eyes and other signs that pathological processes have begun.

However, if a veil appears before the eyes, which can occur quite suddenly at any time, “spots” before the eyes, or there are difficulties with reading, then this is a symptom that the pathology has begun to progress, and there has been a change in the fundus in diabetes mellitus.

As soon as diabetes is diagnosed, the doctor recommends that the patient visit an ophthalmologist to have their vision checked. Such an examination should be carried out every year in order to prevent complications with the eyes in time.

The standard vision examination procedure includes the following points:

• Visual acuity is checked, its boundaries are clarified.
• The bottom of the eye is examined.
• Intraocular pressure is measured.
• Eye ultrasound (rare).

It should be noted that eye manifestations in diabetes mellitus are most often found in those patients who have a long history of the disease. According to statistics, after 25 years of fighting pathology, the percentage that eye diseases will develop in diabetes mellitus is approaching the maximum.

Changes in the fundus of the eye in diabetes mellitus proceed slowly. On the initial stage the patient can feel only a slight deterioration in visual perception, blurred vision, “flies” before the eyes appear.

At a later stage, the problem worsens significantly, as do its symptoms: the patient's vision is sharply reduced, he practically does not distinguish between objects. If you ignore the situation, then the loss of vision in diabetes is a matter of time.

It must be said that in the vast majority of cases, the process of visual impairment can be noticed in time.

Usually, in many patients, a sign of decreased vision is already observed at the time of diagnosis.

Sugar level

The retina is a group of specialized cells in the human body that turn light entering the lens into a picture. The ophthalmic or optic nerve is the transmitter of visual information, and directs it to the brain.

Diabetic retinopathy is characterized by a change in the vessels of the fundus, a violation of the functionality of blood vessels, which becomes a consequence of the progression of the underlying disease.

Reduced vision in diabetes is due to the fact that small vessels are damaged, and this condition is called microangiopathy. Microangiopathy includes diabetic disorders of the nerves, as well as pathologies of the kidneys. In the case when damage to large blood vessels has occurred, the pathology is called macroangiopathy, and it includes such diseases as heart attack and stroke.

Studies of the complications of the "sweet" disease have found that there is a definite connection between the disease and microangiopathy. In connection with the established relationship, a solution was found. To cure the patient, you need to normalize the sugar content in his body.

Features of diabetic retinopathy:

1. In type 2 diabetes, diabetic retinopathy can cause vascular changes that are irreversible, resulting in complete loss of vision in diabetes.
2. The longer the experience of the underlying pathology, the higher the likelihood that inflammation of the eyes will develop.
3. If not found in time inflammatory process, and not to take a number of measures aimed at improving vision, then it is almost impossible to protect the patient from blindness.

It should be noted that retinopathy in small patients with the first type of pathology develops extremely rarely. Most often, pathology manifests itself precisely after puberty.

Many patients are interested in how to protect the eyes in diabetes? Protecting your eyes is essential from the moment you are diagnosed. And the only way that helps prevent complications is to control blood sugar, keeping it at the required level.

Clinical studies show that if you control your glucose, follow all the doctor's recommendations, eat right, lead an active lifestyle and regularly visit an ophthalmologist, you can reduce the likelihood of developing pathology by 70%.

Background retinopathy is characterized by the fact that with damage to small blood vessels, there are no signs of impaired visual perception. At this stage, control of the concentration of glucose in the body is of particular importance. This helps to exclude the development of other eye pathologies, and will not allow background retinopathy to progress. The fundus of the eye, in particular its vessels, change in the limbus.

Maculopathy. At this stage, the patient has lesions in a critical area called the macula. Due to the fact that the damage was formed in a critical area, which has an important functionality for full visual perception, there is a sharp decrease in vision.

Proliferative retinopathy is characterized by the formation of new blood vessels on the back surface of the visual organ. Due to the fact that such a disease is a complication of diabetes, it develops as a result of insufficient oxygen supply to broken blood vessels. The fundus of the eye and areas in the posterior segment of the eye are destructively changed.

A cataract is a darkening of the lens of the eye, which normally has a transparent appearance. Through the lens, a person can distinguish objects and focus the picture.

If you do not take into account the fact that cataracts can be found in completely healthy people, in diabetics, such problems are diagnosed much earlier, even at the age of 20-25 years. With the development of cataracts, the eye cannot focus pictures. The symptoms of this pathology are as follows:

• A person sees "through the fog."
• Faceless vision.

In the vast majority of cases, to restore vision, you need to replace the bad lens with an implant. Then, in order for vision to improve, a person needs to wear contact lenses or glasses.

With a complication of an eye disease, a diabetic may have a hemorrhage in the eye (as in the photo). The anterior chamber is completely filled with blood, the load on the eyes increases, vision decreases sharply and remains at a low level for several days.

The attending physician will examine the eye and the fundus of the eye, and give prescriptions that will help improve vision.

Treatment

What to do if vision began to decline, and what methods of treatment can restore it, patients ask? Eye treatment for diabetes begins with the normalization of the diet and the correction of metabolic disorders.

Patients should constantly monitor the content of glucose in the body, take sugar-lowering medications, and monitor their carbohydrate metabolism. However, it is currently ineffective to treat severe complications conservatively.

Laser coagulation of the retina is a modern method of treatment for diabetic retinopathy. The intervention is performed on an outpatient basis under anesthesia, the duration of the procedure is no more than five minutes.

Manipulation is usually divided into two stages. It all depends on the degree of damage to the fundus, and violations of blood vessels. This procedure greatly helps to restore vision to patients.

Treatment for diabetic glaucoma includes:

1. Taking medications.
2. Eye drops are recommended.
3. laser procedure.
4. Surgical intervention.

Vitrectomy is an operating procedure that is used for vitreous hemorrhage, retinal detachment, as well as for severe injuries of the visual analyzer against the background of diabetes mellitus.

It is worth saying that such an intervention is carried out only in cases where it is not possible to restore vision by other options. The operation is performed under general anesthesia.

The surface of the eye must be cut in three places, as a result of which an area is freed up that allows the doctor to manipulate the retina and vitreous body. The vitreous body is completely sucked off by means of a vacuum, and pathological tissues, scars, and blood are removed from it. Then the procedure is performed on the retina of the eye.

If a patient has eye manifestations in diabetes mellitus, there is no need to drag out time, hoping that everything will pass by itself. You can not self-medicate, not a single manual will give an answer on how to fix the problem. It is necessary to consult a doctor promptly, and then it will be possible to restore visual perception.

How to protect yourself?

Prevention, which allows you to prevent complications with the eyes or stop their further progression, includes the use of vitamin preparations. As a rule, they are recommended at an early stage of the disease, when there is still sharp vision, and there are no indications for surgery.

Alphabet Diabetes - diabetic vitamin complex, which improves vision, includes plant components in its composition. The dosage is always selected exclusively by the doctor, taking into account the general condition of the patient, the likelihood of complications, laboratory blood counts.

The second type of diabetes involves a specific diet, and it is not always possible to get all the necessary vitamins and beneficial components from food. To fill them will help - a vitamin and mineral remedy that helps protect the visual apparatus by extracting blueberries, lutein, beta-carotene.

Patients with diabetes can significantly reduce the chance of eye complications if they control their blood glucose and see their ophthalmologist regularly. The video in this article will continue the topic of vision problems in diabetes.

Laser coagulation of the retina

Diabetic retinopathy is a specific complication of diabetes mellitus, the treatment of which is one of the priorities of modern world medicine. More than twenty-five years of experience in the use of laser coagulation of the retina shows that at present this method is the most effective in the treatment of diabetic retinopathy and the prevention of blindness.

Timely and qualified treatment allows you to save vision in the later stages of diabetic retinopathy in 60% of patients for 10-12 years. This figure may be higher if treatment is started at an earlier stage.

In the affected parts of the retina, endothelial vascular growth factor is produced, which stimulates vascular proliferation. Laser coagulation of the retina is aimed at stopping the functioning and regression of newly formed vessels, which represent the main threat of the development of disabling changes in the organ of vision: hemophthalmos, traction retinal detachment, iris rubeosis and secondary glaucoma.

Thus, the essence of laser exposure is reduced to:

• destruction of avascular areas of the retina, which are the source of the release of growth factors of newly formed (inferior) vessels, which are the source of hemorrhages in the eye cavity and retinal edema,
• an increase in the direct supply of oxygen to the retina from the choroid,
• thermal coagulation of newly formed vessels.

Laser photocoagulation techniques

Focal laser coagulation of the retina (FLC) consists in applying coagulates in places where fluorescein is translucent during fluorescein angiography of the fundus, in areas of localization of microaneurysms, small hemorrhages, exudates. Focal laser coagulation of the retina is used to treat diabetic maculopathy with focal or diffuse retinal edema in the central regions.

Damage to the central region of the retina can be observed with diabetic retinopathy of any severity, more often with proliferative, and is a particular manifestation of diabetic retinopathy. Despite the significant advances in modern ophthalmology recent years, diabetic macular edema occurs in approximately 25-30% of patients with diabetes mellitus for 20 years or more, being the main cause of reduced central vision. The main signs that affect the state of visual functions and the prognosis for vision are edema and ischemia of the central parts of the retina. Great importance also has the removal of pathological foci from the center of the macula.

Depending on the clinical picture, focal laser coagulation of the retina is performed according to the "lattice" method in case of diffuse maculopathy, and a focal "micro-lattice" in case of focal or mixed macular retinal edema.

The results of laser treatment of diabetic maculopathy to a large extent depend on its clinical features, the stage of macular edema and the technique of laser coagulation of the retina. Complete regression of macular retinal edema after laser treatment is achieved in approximately 63.2% - 86.4% of patients. Undoubtedly, the treatment of retinopathy with macular edema is most effective when laser coagulation of the retina is performed at an early stage, with high visual functions and minimal deposits of hard exudates, accompanied by a significant improvement and even complete restoration of visual functions.

Glycemic control is the cornerstone of the treatment of all manifestations of diabetes mellitus, including diabetic macular edema. Compensation for violations of carbohydrate, fat and protein metabolism, normalization of blood pressure are necessary to effectively combat the edematous process of the retina. In this case, it is possible to maintain high visual acuity for many years in most patients.

Panretinal laser coagulation of the retina (PRLC). Panretinal laser coagulation of the retina, as a treatment for diabetic retinopathy, was developed and proposed by the American ophthalmologists MeyerSchwickerath and Aiello and consists in applying coagulates to almost the entire area of ​​the retina, excluding the macular area.

The main goal of panretinal laser coagulation in the treatment of retinopathy is the laser destruction of all areas of the retina with impaired blood supply. Laser exposure to these areas leads to the fact that the retina stops producing vasoproliferative substances that stimulate neovascularization, causing regression of already existing newly formed vessels, thereby leading to stabilization of the proliferative process. With the timely detection of newly formed vessels, laser coagulation of the retina can prevent blindness in the vast majority of cases.

This method is used mainly in the proliferative form of diabetic retinopathy and in preproliferative diabetic retinopathy, characterized by the presence of extensive areas of retinal ischemia with a tendency to further progression.

Depending on the stage of diabetic retinopathy, the form of maculopathy, your treatment may include an average of 3-5 stages of 500 - 800 burns per treatment session with an interval between sessions of 2 - 4 months.

Laser treatment of diabetic retinopathy in cases with a rapidly progressive form of fibrovascular proliferation in type 1 diabetes mellitus, in the presence of newly formed vessels of the optic nerve head, the rapid progression of the process in the other eye, or in case of neovascularization of the anterior segment of the eye, implies a more active, "aggressive" tactic and maximum volumes of laser coagulation of the retina . In such cases, it is possible to perform at least 1000 coagulates in the first session, followed by the addition of another 1000 coagulates in the second session, usually held a week later.

Treatment of retinopathy in diabetes mellitus must necessarily include follow-up examinations of patients and, if necessary, additional laser treatment. As a rule, the first examination after primary laser treatment (panretinal retinal laser photocoagulation) should be carried out after 1 month. In the future, the frequency of examinations is determined individually, on average 1 visit every 1 to 3 months, depending on the severity of diabetic retinopathy.

Laser coagulation of the retina is effective in 59% - 86% of cases, allowing to achieve stabilization of the proliferative process and preserve vision for many years in most patients with diabetes mellitus, provided that such systemic factors as hyperglycemia, hypertension, nephropathy, heart failure are adequately corrected.

Laser treatment aims to prevent further reduction in visual acuity! Timely laser coagulation of the retina helps to avoid blindness!

The effectiveness of laser coagulation of the retina in diabetic retinopathy is beyond doubt. However, a number of clinical conditions limit the use of the laser and, first of all, is the clouding of the optical media. In such cases, a transscleral cryoretinopexy may be performed.

Transscleral cryoretinopexy

The therapeutic mechanism of cryoretinopexy is similar to laser coagulation. Cold destruction of the retina (applicates are applied through the sclera) leads to atrophy of the ischemic zones, and, consequently, to the improvement of metabolic processes and blood circulation in the retina and the regression of newly formed vessels.

Indications due to the state of optical media. There is no doubt that the transparency of the media and good pupil dilation are necessary for laser coagulation of the retina. Cryotherapy has the advantage that it can be successfully carried out under optically less favorable conditions under the control of binocular ophthalmoscopy, which allows bright illumination and a large field of view, or under chronometric control.

Lack of effect from laser coagulation of the retina. Another important indication for cryotherapy is the lack of the desired effect of PRLC, when progression continues after a properly performed treatment or there is no sufficient regression of neovascularization (especially of the iris or anterior chamber angle). Then panretinal cryoretinopexy is a fast and effective method of destroying additional areas of the hypoxic retina.

Severe proliferative diabetic retinopathy, complicated by vitreous hemorrhage, traction retinoschisis, or retinal detachment, may develop despite panretinal laser coagulation of the retina or cryoretinopexy.

In these cases, it is indicated surgical treatment to prevent permanent loss of vision.

Surgical treatment of diabetic retinopathy. Vitrectomy

Unfortunately, quite often patients come to us with advanced stages of diabetic retinopathy, when laser coagulation of the retina is not able to stop the process or is already contraindicated. As a rule, the causes of a sharp deterioration in vision are extensive intraocular hemorrhages, severe fibrovascular proliferation, and retinal detachment. In such cases, only surgical treatment of diabetic retinopathy is possible. Over the past 25 years, ophthalmic surgery has made significant progress in the treatment of this severe pathology. The operation performed for the proliferative phase of the process is called vitreectomy. Robert Machemer became the founder of vitreous surgery in the early 1970s.

The vitreous body in proliferative retinopathy undergoes gross destructive and proliferative changes. Proliferation into the vitreous body can occur in various ways. Most often, newly formed retinal vessels spread along the posterior surface of the vitreous body, using the posterior hyaloid membrane of the vitreous body bordering the retina as a scaffold, leading to its fibrous degeneration. These vessels are abnormal both in their location and structure - the wall of the newly formed vessels is thin and fragile. Such vessels are potential sources of extensive hemorrhages even against the background of normal blood pressure, without any physical exertion, with good compensation for diabetes mellitus. All this leads to recurrent hemorrhages in the vitreous body and the formation of fibrovascular membranes not only along the posterior surface of the vitreous body and the surface of the retina, but also inside it. The next stage of the proliferative stage of the process is the "maturation" of fibrovascular membranes, which have a pronounced ability to contract. Attached to the retina, in the course of their contraction, they stretch the retina, and, ultimately, lead to retinal detachment. This is how retinal detachments, which are characteristic of diabetes mellitus, appear - the most severe in terms of surgical treatment and according to forecasts of visual functions.

Modern technologies of vitreoretinal surgery using silicone oil, perfluorocarbon liquids, endolasers, development of new vitreectomy tools and techniques, microinvasive vitrectomy of 23Ga, 25Ga format optimize the results of treatment of patients with severe manifestations of diabetic retinopathy. Vitrectomy is the main treatment for severe complications of proliferative diabetic retinopathy, aimed at maintaining and improving visual acuity in patients with diabetes mellitus. Vitrectomy surgery has the most pronounced effect in the early stages of proliferative retinopathy, indications for surgery are: intravitreal hemorrhage (hemophthalmos), progressive fibrovascular proliferation, proliferative angioretinopathy with vitreoretinal traction, traction retinal detachment, traction-rhegmatogenous retinal detachment.

You can learn more about vitrectomy for diabetic retinal damage in our video

Technically, vitrectomy is a surgical procedure. high category complexity, requires the highest qualification surgeon and special operating room equipment. Such operations are performed only in very few ophthalmological clinics. The operation of vitrectomy consists in the removal of the altered vitreous body in the fullest possible volume, excision of fibrovascular membranes and elimination of traction on the retina. During the operation, an obligatory step is the removal of the posterior hyaloid membrane of the vitreous body, which is the basis of fibrovascular proliferation and a key link in the progression of diabetic retinopathy. In order to prevent surgical and postoperative complications, endovitreal diathermy or photocoagulation, or transscleral cryocoagulation, is widely used. At the end of the operation, the vitreous cavity is filled with one of the necessary drugs: balanced saline, liquid silicone, perfluorocarbon compound (PFOS) in the form of a liquid or a special gas.

Depending on the specific manifestations of diabetic retinopathy, the condition of the vitreous body and the retina, our specialists will choose one of the specific methods of surgical treatment. The combination of these interventions is selected individually for each patient.

Retinal changes in diabetes are very severe, but the situation is not fatal. The main task of patients suffering from diabetes is to adequately control diabetes, hypertension, nephropathy. Regular observation by a laser ophthalmic surgeon, at least 2 times a year, despite good visual acuity, timely laser and surgical treatment will help to avoid blindness.

A comprehensive and individual approach to the choice of the method of treatment of eye manifestations of diabetes mellitus, offered in our clinic, allows you to save the eyesight of patients suffering from this disease.

Diabetes mellitus can damage both the elements of the fundus (the back wall of the eyeball, the retina) and the lens (“lens” located in front of the eye and collecting light rays).

Damage to the fundus (retina) in diabetes is called diabetic retinopathy(DR).

DR is a microvascular complication of diabetes mellitus. A feature of diabetic retinopathy is that pronounced vascular changes in the fundus may not lead to a decrease in vision for a long time, and then vision is sharply and often irreversibly reduced.

Retinopathy can be asymptomatic, and the patient himself cannot adequately assess the condition of the fundus by the quality of vision. This causes diabetic patients.

Factors in the development of diabetic retinopathy

The duration of diabetes is the most significant risk factor. Diabetic retinopathy rarely develops in the first 5 years of the disease or before puberty, but in 5% of patients with type 2 diabetes, diabetic retinopathy is detected at the same time as the diagnosis of diabetes.

High sugar levels are no less a significant risk factor than the duration of the disease. It is known that good management blood sugar levels can prevent or slow down the development of diabetic retinopathy.

Diabetic (nephropathy) causes worsening of diabetic retinopathy.

Other risk factors include being overweight, hyperlipidemia, and anemia.

Diagnosis of retinopathy

It should be carried out with a dilated pupil by a competent specialist using an ophthalmoscope. Pupil dilation is achieved by preliminary (approximately 30 minutes before the doctor's examination) instillation of special drops into the eyes. Pupil dilation is accompanied by a decrease in near vision. The action of the drops lasts about 2-3 hours.

It is recommended to refrain from driving a car for this time, a large visual load: reading, working on a computer; on a sunny day, it is better to use sunglasses. In addition, the ophthalmologist's examination includes: checking visual acuity, examining the anterior part of the eye for the presence of cataracts (clouding of the lens) and, if necessary, measuring intraocular pressure.

In addition, to document changes in the retina and to assess the dynamics of the state of the fundus, serial photographs of the fundus are sometimes taken using a fundus camera.

In some cases, fluorescein angiography of the fundus vessels is performed to detect changes that are not visible during a routine examination.

All patients with diabetes mellitus should be examined prophylactically by an ophthalmologist once a year. In the presence of changes in the fundus - every six months or more.

Stages of diabetic retinopathy

There are currently 3 stages of diabetic retinopathy. Treatment of DR depends on the stage of the process:

• The initial form of diabetic retinopathy(DR) is called non-proliferative. These minimal changes on the retina develop sooner or later in almost every patient with DM and do not affect vision. This stage can proceed stably for quite a long time, without deterioration, and against the background of compensation for diabetes and a decrease in blood pressure, it can even regress. Treatment includes normalization of sugar levels and blood pressure.
• The next stage of DR is preproliferative retinopathy. At this stage, vision also does not change yet. But this stage, if left untreated, can quickly progress to the next stage of retinopathy. Treatment includes, in addition to normalizing sugar levels and blood pressure, laser coagulation of the retina.
• The most severe form of retinopathy is proliferative retinopathy. Even at this stage, vision may be good for a while. Sometimes the patient notes the appearance of floating dark spots before the eye. However, pronounced proliferative changes are noted in the fundus - the growth of newly formed vessels and connective tissue, which can lead to an irreversible decrease in vision, blindness, and even death of the eye. At this stage, urgent laser coagulation of the retina is mandatory. However, treatment at this stage does not always give a lasting positive effect.

With the progression of the process in the fundus, the development of hemorrhage in the eye cavity is possible - hemophthalmos leading to a sharp decrease in vision. Possible development neovascular glaucoma accompanied by complete irreversible loss of vision and severe pain in the eye. In addition, retinal detachment may occur.

All these consequences of the proliferative stage of retinopathy require complex surgical interventions on the eyes, but even they do not always allow vision to be restored.

Therefore, it is better to prevent diabetic eye damage than to restore lost vision.

Prevention of retinopathy

Years of research have found that people with diabetes who keep their sugar levels close to normal have fewer eye complications than those who manage their sugar levels poorly. Proper nutrition and exercise play a significant role in general condition health of diabetic patients.

People with diabetes can greatly reduce their risk of eye complications by seeing their ophthalmologist regularly. Most complications are treated much more successfully if detected early.

Diabetic cataract

Another complication of diabetes in the eyes is cataract- Diabetic cataract. Clouding of the lens can occur with any duration of diabetes. Especially often cataracts develop in patients with high sugar levels. Clouding of the lens causes decreased vision.

Prevention of diabetic cataract

Prevention of cataract development is the maintenance of optimal blood sugar levels. Against this background, it is possible to instill drops that slow down the development of clouding of the lens. But unfortunately, no drops and tablets can completely prevent the development of cataracts, and even more so eliminate existing lens opacities.

Treatment of diabetic cataract

Cataract treatment is surgical: removal of the clouded lens and implantation of an artificial lens.

Currently, the operation of choice for patients with diabetes mellitus is the technique of seamless cataract removal using ultrasound - phacoemulsification.

This operation is performed without incisions, with the help of 2 small eye punctures. The cloudy lens is crushed by ultrasonic waves and aspirated through another puncture. A soft lens (artificial lens) is inserted through the same puncture.

The low invasiveness of this operation leads to rapid healing and makes it possible to carry it out without hospitalization of the patient. In addition, this operation is performed on an immature cataract, i.e. you don’t have to wait until the lens is completely clouded, when you can’t see anything at all, but you can remove the lens when the quality of your vision no longer suits you.

Cataract removal will not only improve the quality of vision, but will also enable the oculist to examine your fundus well for early detection of vascular retinal changes - retinopathy.