What is diabetic retinopathy? What drops are used for the prevention and treatment of eyes in diabetics

He is insidious not only in himself. It causes a number of complications that significantly reduce the quality of life. One of these complications is eye damage. In diabetes mellitus, visual impairment occurs due to the destruction of the retina. It is irreversible, requires long-term persistent treatment, and in advanced cases leads to blindness.

Table of contents:

Diabetic retinopathy - what is it?

Diabetic retinopathy is one of the “three” diseases that ophthalmologists are most concerned about. With this disease, the vessels of the retina of the eyeball are affected. Their anatomical and physiological disorders are caused by increased level blood sugar. If ten years ago, diabetic retinopathy in most cases tormented older patients (50 years and older), now it is rapidly “getting younger”, and doctors are no longer surprised by cases of damage to the eye vessels in diabetes mellitus in patients aged 23-28 years.

The longer a person is sick diabetes mellitus, the greater the likelihood that he will be struck down by diabetic retinopathy. In patients in whom diabetes mellitus has been diagnosed for 5-7-10 years, diabetic changes in the retina of varying severity are observed with a frequency of 45% to 80% of clinical cases, and over 15 years - from 87% to 99%. In total, diabetic retinopathy affects, according to various sources, 85-90% of patients suffering from diabetes, regardless of the duration of the disease.

In the vast majority of cases, complaints about visual impairment due to this disease appear after its long-term course. This is a kind of diagnostic clue - loss of visual acuity in the early stages of diabetes mellitus indicates:

concomitant pathology, which should doubly alert the ophthalmologist, because such a disease will also progress due to diabetes;
less often - about rapidly developing diabetic changes in tissues, provoking deterioration of eye function; treatment correction depends on this.

If you do not take care of the patient, then, inevitably deteriorating vision, diabetes sooner or later leads to blindness, which is actually synonymous with disability. Loss of vision in patients with diabetes mellitus occurs 25 times more often than in cases of blindness caused by other causes. According to various sources, from 2% to 5% of those suffering from diabetic retinopathy suffer from complete loss of vision. Most of the people you meet on the street wearing dark glasses and tapping a stick are blind due to the “sweet” disease.

Reasons for the development of retinopathy

The immediate cause of diabetic retinopathy is hyperglycemia (increased levels of). It leads to destructive changes in the walls of blood vessels through which blood circulates. The first and main blow is taken by the endothelium - the inner lining of blood vessels.

Factors contributing to retinal vascular damage in diabetes mellitus:

An important role in the occurrence of diabetic retinopathy is played by the hereditary peculiarity of the structure of the vascular wall. . If someone in one of the generations suffered from it, the chances of their descendants getting sick are two or more times higher than those who were the first in their family to develop diabetes.

The most dangerous combination of factors leading to diabetic retinopathy is the simultaneous occurrence of hyperglycemia and high blood pressure.

Pathogenesis

The pathogenesis (development) of diabetic retinal vascular damage is complex. It is based on a violation of microcirculation, that is, defects in the “cooperation” of the smallest vessels and tissues to which the vessels supply oxygen and nutrients. As a result, metabolic (metabolic) changes occur in the retinal cells.

The following structures of the retina are mainly affected:

arterioles(small arteries that are not yet anatomically capillaries) - most often they are deformed due to sclerosis (excessive formation connective tissue); their precapillary segments in the posterior part of the fundus are most often affected;
veins– their expansion and deformation (curvature) is observed;
capillaries– most often their dilatation is observed (expansion, “loosening” of one of the local areas), permeability increases significantly. With diabetic damage to the retina, the capillaries can swell, this can lead to complete blockage and cessation of the inflow and outflow of blood through them with all the ensuing metabolic consequences. Also, with diabetic retinopathy, the retinal capillaries are significantly affected by the proliferation of endothelium and the formation of microscopic aneurysms.

“Sweet” blood acts on the vessel wall in two ways – it can:

become thinner and deformed;
thicken and become deformed.

In both cases, morphological changes lead to disruption of blood flow. This in turn entails:

oxygen starvation of the tissues of the retina of the eye;
disruption of the flow of proteins, fats, carbohydrates, and minerals into tissues;
disruption of the removal of waste products from cells.

Hyperglycemia also causes damage to the blood-retinal barrier. It consists of:

endothelium (cells lining the inside of the retinal vessels);
pigment epithelium of the retina.

Normally, the blood-retinal barrier does not allow too large molecules to enter from blood vessels in the tissue of the retina of the eye, thereby protecting the retina from their destructive effects. When endothelial cells are affected in diabetes mellitus, their ranks thin out, the blood-retinal barrier becomes more permeable and is no longer able to withstand the onslaught of large molecules, which is fraught with damage to the life of the retina.

The retina of the eye is formed nerve cells. All nerve structures are characterized hypersensitivity To negative factors and cannot be restored. That is why, if the process of their destructive changes due to starvation has been started, it cannot be reversed - except perhaps stopped in order to preserve the remaining vital cells. This clearly explains the danger of diabetic retinopathy - you can prevent diabetic eye damage at some stage, but you cannot restore lost vision. It should also be taken into account that the retina consumes more oxygen per unit area than other tissues human body. Therefore, even minimal, but constant oxygen starvation can be critical for her: ischemic areas very quickly become dead, so-called cotton wool-like areas develop - local foci of retinal infarction.

In diabetes mellitus, the vessels of not only the retina of the eye are affected. But diabetic retinopathy is the most common of all diabetic lesions of small vessels (microangiopathies).

The general scheme of development of pathological changes in diabetic retinopathy is as follows:

Classification

Ophthalmologists are guided by several classifications of diabetic retinopathy.

The most common is the classification that was proposed in 1992 by doctors Kohner E. and Porta M. and adopted by the World Health Organization. According to it, three forms of the disease are distinguished:

non-proliferative retinopathy (diabetic retinopathy I);
preproliferative retinopathy (diabetic retinopathy II);
proliferative retinopathy (diabetic retinopathy III).

At nonproliferative retinopathy In the retina, upon examination, emerging and already formed vascular microaneurysms are visible. Foci of hemorrhages are observed - first in the form of dots, which grow to rounded spots (sometimes hemorrhages are detected in the form of strokes and short dotted lines). They are dark in color, identified in the central area of the fundus, and when examining the deep zones of the retina, along the course of larger veins. Also, closer to the center of the retina, pockets of exudate (sweating, or in simple words - moisture), white and yellow in color, partly with clear, partly with blurred boundaries, are detected. An important point: with non-proliferative retinopathy, retinal swelling is always observed; if it is not there, this is another form of diabetic retinopathy. Swelling should be looked for in the central part of the retina or near large veins.

At preproliferative retinopathy changes are visible in the retinal veins. They look like rosaries (like large beads strung on a thread), twisty, and in some places - in the form of loops. If normally the diameter of the veins was more or less the same, then with preproliferative retinopathy it fluctuates significantly. “Cotton-like” (like cotton wool balls, unevenly “fluffy”) exudates are observed. A large number of retinal hemorrhages are also observed.

At proliferative retinopathy changes are observed not only in the retina, but extend beyond it. Fragments of the retina sprout new vessels - this process primarily affects the optic disc. Throughout the volume vitreous a lot of diffuse hemorrhages are determined - both pinpoint and merging with each other and forming peculiar conglomerates. After some time, a fibrous tissue, replacing areas of the vitreous body. Hemorrhages are a poor prognostic sign: after the primary ones, secondary ones may occur, which will lead to blindness. Another serious complication is rubeosis (sprouting of the vessels of the iris) - a direct path to the occurrence of secondary.

A classification is also used that takes into account the morphological manifestations of the stages of diabetic angiopathy. It is described in National leadership on eye diseases. According to it, diabetic retinopathy has two forms:

preproliferative;
proliferative.

In turn, the following phases are distinguished in the preproliferative form:

In the National Guide to Eye Diseases the proliferative form is characterized by the following forms:

with tissue germination by blood vessels (neovascularization);
with gliosis;
with partial or complete detachment of the retina.

Gliosis is an increased number of glia, which consists of cells that fill the space between neurons. According to the classification, diabetic retinopathy is divided into 4 degrees:

with gliosis grade 1 glial cells are observed in the posterior fragment of the retina or its middle section in the area of the vascular arcades (arches), but do not capture the optic nerve head;
gliosis grade 2 extends to the optic nerve head;
with gliosis grade 3 glia equally extend to both the optic disc and the vascular arcades;
gliosis grade 4– the most dangerous, with glia in the form of circular stripes spreading to the optic nerve head, vascular arches (arcades) and areas between the arcades.

Clinical classification classifies diabetic retinopathy into 4 types- This:

focal edematous– during an ophthalmological examination of the retina, foci of edema are determined;
diffuse edematous– swelling spreads throughout the entire retina;
ischemic– initially, changes in the vessels of the retina predominate, which lead to its oxygen starvation;
mixed– swelling of the retinal tissue and ischemic changes are simultaneously observed.

Symptoms of diabetic retinopathy

In the early stages of diabetic retinopathy clinical symptoms none– the patient is not bothered by decreased visual acuity, pain, or visual distortion. If a patient with diabetes complains that he has trouble seeing, this means that pathological process in the retinal tissues has gone far, moreover, it is irreversible.

Clinical manifestations of diabetic retinopathy are as follows:

If a patient with diabetes mellitus has “floaters” and blurred vision before their eyes, it is necessary to contact an ophthalmologist urgently for help, otherwise they may lose their vision at lightning speed.

Diagnostics

Since the clinical symptoms of diabetic retinopathy appear late, instrumental methods for examining the retina are important for timely diagnosis:

straight– study of the retina directly;
indirect, when other fragments of the eyeball are studied, changes in which may indirectly indicate disorders in the retina of the eye.

First of all, the following research methods are applicable:

viziometry;
determination of eye pressure;
biomicroscopic examination of the anterior parts of the eye.

If the patient’s intraocular pressure is within normal limits, then methods that require drug dilation of the pupils can be used for research:

Two latest methods are considered the most sensitive and informative in detecting changes in retinal vessels caused by diabetic retinopathy.

The ophthalmologist examines not only the retina, but other parts of the eyeball for the purpose of differential (distinctive) diagnosis, since “spots”, blurred vision, and decreased visual acuity are inherent in other ophthalmological diseases (and not only ophthalmological ones).

Treatment of diabetic retinopathy, principal approaches and methods

Appointments are made jointly by an endocrinologist and an ophthalmologist. The most important point in the treatment of diabetic retinopathy are prescriptions aimed against diabetes mellitus - first of all, regulation of blood sugar levels. If the latest methods are used to treat a nosology, but blood sugar is not regulated, all the manipulations performed will lead to a positive effect for a very short time.

It is important therapeutic diet. Its basic rules:

limit fats to the maximum, replace animals with vegetable ones;
lean on foods that have a high content of lipotropic substances - these are all types of fish, homemade cottage cheese, oatmeal different types(cereals, cereals), fruits, vegetables (except potatoes);
forget about easily digestible carbohydrates - these include jam (even subjectively it doesn’t taste very sweet), all types of sweets, sugar.

Diabetic retinopathy requires serious intervention - in particular, invasive (involving penetration into the tissue of the eyeball). Despite the high degree of harmfulness of the processes underlying diabetic retinopathy, it is possible to save a patient from blindness in 80% of cases of intervention by using invasive treatment methods.

Laser photocoagulation – local, “point” cauterization of the affected areas of the retina, which is performed to stop the pathological proliferation of blood vessels. Performed using a laser coagulator. The principle of the procedure is simple: blood clots in the cauterized vessels, the process of their deformation stops, swelling and retinal detachment, the “extra” vessels that have already formed are overgrown with connective tissue.

This is one of the most effective methods treatment of diabetic retinopathy. If it is performed on time, then the destruction of the retina can be stopped:

in 75-85% of cases, if photocoagulation was performed at the preproliferative stage;
in 58-62% of cases, if photocoagulation was applied during the proliferative stage of the process.

Even if this method is applied in the later stages of pathology development, vision can still be preserved in 55-60% of patients for 9-13 years. Sometimes in such patients, immediately after the manipulation, visual acuity decreases - in particular, night vision deteriorates. But these are digestible results in comparison with the fact that the germination of the retina by new vessels, which act destructively on it, will be stopped.

If vitreous hemorrhages occur during diabetic retinopathy, vitrectomy . This is an operation that is performed under anesthesia. It is prescribed in the following cases:

The following medications are also used:

antioxidants – binding free radicals, preventing damage to retinal vessels;
vascular strengthening agents – prevent fragility of the retinal vascular wall;
enzyme preparations - help to dissolve clots caused by hemorrhages;
drugs that prevent the growth of new blood vessels (Avastin, Lucentis and others);
vitamins are, first of all, representatives that significantly strengthen the vascular wall. Vitamins C, P, E are also effective. All of them should be used both internally (pharmacy vitamin complexes, natural in products) and by injection - it is better to alternate the method of administration.

Prevention

Preventative measures by which doctors can prevent diabetic retinopathy are all those methods that are aimed at competent treatment diabetes mellitus, stabilizing its course and bringing it into a controlled direction. This:

correct prescription (in particular insulin);
constant monitoring of urine levels;
well-written;
preventive use of medications that will maintain the proper condition of the retinal vessels (angioprotectors, vitamins);
categorical refusal bad habits– first of all, smoking in any form.

Even if all these instructions are carried out with extreme punctuality, subjective state the patient is satisfied with him and the attending physician, and there is not the slightest change in vision - It is necessary to undergo examinations by an ophthalmologist with enviable regularity. But not superficial, at the level of conversation, but complete, using all possible instrumental methods diagnostics Due to the delicacy of the retina, diabetic retinopathy can develop very quickly and just as quickly lead to irreversible changes in the structures of the eyeball - primarily the retina and vitreous body.

Forecast

If diabetic retinopathy is detected in its earliest stages, vision can be saved. Since blood sugar has a destructive effect on the walls of the retinal vessels, over time, vision will gradually deteriorate even with ideal treatment - but these deteriorations are not catastrophic. Patients who strictly follow the correct medical prescriptions, adhere to healthy image Those who regularly visit a competent ophthalmologist are not in danger of blindness.

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

Main symptoms:

Ocular hemorrhages
Blurred vision
Veil before my eyes
Appearance of dark spots in the field of vision
Decreased vision
Difficulty reading small text

Diabetic retinopathy is a disease characterized by damage to the vessels of the retina and impaired visual perception of the cornea. The pathology develops against the background of insulin-dependent and non-insulin-dependent forms of diabetes mellitus. As a result of its progression, visual function is significantly reduced, up to complete loss of vision (without the absence of timely treatment).

To save vision in the presence of diabetic retinopathy, invasive interventions are used. Cauterization of the retina using a laser is highly effective, as well as complete removal vitreous body (this technique is used in difficult situations).

Etiology

The main reason for the progression of diabetic retinopathy is the presence of long-term symptoms. Medical statistics are such that the pathology is diagnosed in 15 out of 100 people with diabetes mellitus that has lasted for two years. If the duration of the disease is 15 years, then retinopathy is diagnosed in 50% of patients.

Factors that increase the risk of diabetic retinopathy:

Factors that are “triggering” for the progression of the disease:

adolescence;
smoking;
pregnancy (only if treatment for diabetes mellitus was started during the period of pregnancy);
genetic predisposition.

Mechanism of disease progression

Diabetic retinopathy begins to gradually develop due to the increased concentration of sugar in the vessels of the retina. As a result, the vascular wall is damaged. Most often, small-caliber vessels that provide nutrition to the retina are attacked. Hyperglycemia leads to:

when the walls of blood vessels are damaged, a violation of blood microcirculation is observed;
a certain amount of blood that comes out of damaged vessels permeates nearby tissues;
due to the fact that the retina ceases to be fully “nourished”, new blood vessels are formed, which are also destroyed (proliferative diabetic retinopathy);
blocked vessels grow with connective tissue.

Stages

Non-proliferative. This stage is the initial stage in the progression of diabetic retinopathy. During the non-proliferative stage, small-caliber blood vessels (local) begin to dilate in the retina. This process is medically called microaneurysm. As a result, hemorrhages occur in the surrounding tissues. The retina is also impregnated with plasma. As a result, it swells along larger vessels.

At the non-proliferative stage, treatment is simpler. If you start it in a timely manner, then there is a high probability of complete preservation visual function. Treatment of the non-proliferative stage is prescribed only by a qualified ophthalmologist, together with an endocrinologist.

Preproliferative stage (progressive). If it develops, damage to the veins that carry blood from the retina is observed. Limited areas of pathological expansion, loops, and duplications appear in them. During the preproliferative stage, hemorrhages in tissues increase more and more.

Proliferative diabetic retinopathy. Its characteristic manifestation is the ingrowth of new blood vessels into various parts of the retina. They can be localized in the area of the visual spot. Many areas of the vitreous body are saturated with plasma that comes out of damaged blood vessels. Due to the fact that the newly formed vessels have fragile walls, microaneurysms appear in them again, provoking new hemorrhages, which can cause detachment of the retina itself. Proliferative diabetic retinopathy often causes vision loss.

Symptoms

The biggest danger of diabetic retinopathy is that it can occur without a single symptom for a long period of time. At the first stage of diabetic retinopathy, the decrease in visual function is so slight that the patient does not notice it at all. As the pathology progresses, the following symptoms appear:

gradual decrease in visual function;
objects that are located in close proximity to a person begin to appear blurry to him ( characteristic symptom);
Difficulties arise when reading small text.

The proliferative stage is supplemented by the following symptoms:

the decline in visual function progresses;
dark spots or a veil appear before the eyes. This symptom indicates the presence of intraocular hemorrhages. But it is worth noting that they can disappear on their own.

If, in the event of such symptoms, no complex diagnostics and treatment, complete loss of vision may occur without the possibility of recovery in the future. The danger also lies in the fact that the symptoms of this pathology are very scarce and may indicate the progression of any other eye pathologies. Therefore, people who have previously been diagnosed with diabetes should be regularly examined not only by an endocrinologist, but also by an ophthalmologist.

Diagnostics

The most informative methods for diagnosing the disease are:

ophthalmoscopy;
fluorescein angiography;
slit lamp examination.

A slit lamp examination using a special lens allows the doctor to accurately diagnose the presence of pathology even at an early stage of development (detection of retinal edema).

With the help of ophthalmoscopy, it is possible to detect the presence of microaneurysms at the initial stage of the pathology. At the second stage, during the examination, the doctor sees small whitish foci, stripes, deformation of the veins of the fundus and already formed foci of infarction in the fundus. During the proliferative stage, ophthalmoscopy can reveal newly formed vessels and clarify their location.

Additional examination techniques:

visometry;
perimetry;
tonometry intraocular pressure;
electrooculography;
Ultrasound of the eye;
electroretinography;
gonioscopy;
diaphanoscopy.

Complications

If diabetic retinopathy has not been fully treated, a person will develop the following dangerous complications:

hemophthalmos;
retinal disinsertion.

Treatment

Treatment of diabetic retinopathy directly depends on what stage of the pathology was diagnosed in a person.

at stage 1, therapy is usually not prescribed. The doctor prescribes the patient to continue to take glucose-lowering medications, as well as to regularly come for examinations to an ophthalmologist in order to prevent further progression of the pathology;
the second stage is more dangerous. The patient's condition must be constantly monitored, as this stage can quickly progress to the proliferation stage. The doctor needs to constantly monitor the concentration of glucose in the blood. Therapy includes drugs that help eliminate metabolic disorders. Introduction also shown special means directly into the vitreous body.
in the proliferation stage only the right way treatment is the use of an argon laser.

Methods for eliminating the disease:

diet therapy. The patient's diet is limited simple carbohydrates, animal fats. At the same time, it must include oatmeal, vegetables, and fruits;
the endocrinologist develops a specific individual treatment regimen with glucose-lowering drugs;
vitamin therapy;
to reduce retinal edema, glucocorticoid hormones are injected directly into the vitreous;
laser coagulation;
cold exposure – cryoretinopexy;
partial extraction of the vitreous;
removal of the vitreous.

Prevention

To prevent the progression of this dangerous condition is the most adequate correction of diabetes mellitus, which a person already has. It is also important to accept everything necessary measures to eliminate fluctuations in blood sugar levels (dietary correction). Only if these conditions are met, it is possible to “slow down” the progression of the disease, as well as reduce the risk of complications (glaucoma, hemophthalmos).

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

It is one of the most common diseases, affecting more than 5% of the world's population. With diabetes mellitus, the patient's blood sugar level increases, which affects the condition of all blood vessels in the body, as well as the blood vessels retina . Retinal damage caused by diabetes is called diabetic retinopathy, which is the main cause of blindness and disability.

The age of the patient plays an important role in the development of the disease. If diabetes mellitus was diagnosed before age 30, the incidence of retinopathy increases: after 10 years - by 50%, after 20 years - by 75%. If diabetes began after 30 years of age, then retinopathy develops faster and can appear after 5-7 years in 80% of patients. The disease affects patients as insulin dependent , so non-insulin dependent type of diabetes .

Stages of diabetic retinopathy

Diabetic retinopathy consists of several stages. The initial stage of retinopathy is called nonproliferative , and is characterized by the appearance microaneurysms , which dilate the arteries, pinpoint hemorrhages in the eye in the form of dark round spots or streak-like stripes, the appearance of ischemic zones of the retina, retinal edema in the macular area, as well as increased permeability and fragility of the vascular walls. In this case, the liquid part of the blood enters the retina through thinned vessels, leading to the formation of edema. And if the central part of the retina is also involved in this process, then decreased vision.

It should be noted that this form of diabetes can occur at any stage of the disease, and represents the initial stage of retinopathy. If it is not treated, then the transition to the second stage of the disease occurs.

Second stage of retinopathy - proliferative , which is accompanied by impaired blood circulation in the retina of the eye, which leads to oxygen deficiency in the retina ( oxygen starvation , ). To restore oxygen levels, the body creates new blood vessels (this process is called neovascularization ). The newly formed vessels are damaged and begin to bleed, causing blood to enter the retinal layers. As a result, floating clouds appear in the eyes against the background of decreased vision.

In the later stages of retinopathy, as new blood vessels and scar tissue continue to grow, it can lead to retinal detachment and development.

The main reason for the development of diabetic retinopathy is insufficient insulin , which leads to the accumulation fructose And sorbitol , contributing to increased pressure, thickening of capillary walls and narrowing of their lumens.

Symptoms of diabetic retinopathy

The main symptoms of retinopathy depend on the stage of the disease. Typically, patients complain of blurred vision, the appearance of floating dark cloudiness in the eye(midges), and sudden loss of vision. It is important to note that the sharpness of vision depends on blood sugar levels. However, in the initial stages of retinopathy visual disturbances is practically not observed, so patients with diabetes should undergo regular ophthalmological examination to identify the first signs of the disease.

Diagnosis of diabetic retinopathy

People with diabetes should undergo regular eye examinations, so it is possible to detect eye complications in the early stages and begin timely treatment. Diabetics should be under constant supervision not only of a therapist and endocrinologist, but also of an ophthalmologist.

The diagnosis of diabetic retinopathy is made based on the patient's complaints of decreased vision and examination of the fundus using ophthalmoscope . Ophthalmoscopy allows you to identify pathological changes in the fundus. Ophthalmological examinations include determining the level of intraocular pressure, biomicroscopy anterior section eyes.

In addition, fundus photography is performed using fundus cameras , which allow you to document changes in the retina, as well as fluorescein angiography to determine the location of the vessels from which fluid is released and caused macular edema . Biomicroscopy of the lens is performed using a slit lamp.

Treatment of diabetic retinopathy

Treatment of retinopathy depends on the severity of the disease and consists of a number of treatment procedures.

At the initial stages of the disease, therapeutic treatment is recommended. In this case it is assigned long-term use drugs that reduce capillary fragility - angioprotectors ( , parmidine , predian , ), as well as monitoring the maintenance of blood sugar levels. For the prevention and treatment of vascular complications in retinopathy, it is also prescribed . In addition, it is used vitamin P , E , and antioxidants, for example, which includes blueberry extract and beta-carotene. This drug strengthens vascular network, protects them from the action of free radicals, and improves vision.

If the diagnosis of diabetic retinopathy shows major changes, such as the formation of new vessels, swelling of the central zone of the retina, hemorrhages in the retina, then it is necessary to promptly begin laser treatment, and in advanced cases - to abdominal surgery.

In case of swelling of the central zone of the retina ( macula ) and the formation of new bleeding vessels, requires laser coagulation retina. During this procedure, laser energy is delivered directly to the damaged areas of the retina through the cornea, anterior chamber aqueous humor, vitreous body and lens without incisions.

The laser can also be used to cauterize areas of the retina outside of central vision that are starved of oxygen. In this case, the laser destroys the ischemic process in the retina, as a result of which new vessels do not form. Also, the use of laser removes already formed pathological vessels, which leads to a decrease in swelling.

Thus, the main task of laser coagulation of the retina is to prevent the progression of the disease, and to achieve this, several (on average 3-4) sessions are usually performed coagulation , which are performed at intervals of several days and last 30-40 minutes. During a laser coagulation session, you may experience painful sensations, in which it can be used local anesthesia into the tissue surrounding the eye.

A few months after the end of treatment, fluorescein angiography is prescribed to determine the condition of the retina.

Cryocoagulation retina is performed if the patient has severe changes in the fundus of the eye, a lot of fresh hemorrhages, newly formed vessels, and if laser coagulation or vitrectomy is impossible.

If a patient with nonproliferative diabetic retinopathy develops a vitreous hemorrhage that does not resolve ( hemophthalmos ), then it is assigned vitrectomy. It is advisable to perform this operation in the early stages, which significantly reduces the risk of complications from diabetic retinopathy.

During a vitrectomy, the doctor removes the vitreous and the blood that has accumulated here, and replaces it with saline solution(or silicone oil). At the same time, the scars that cause retinal tears and detachment are cut with a laser ( diathermocoagulator ) bleeding vessels are cauterized.

In the treatment of diseases such as diabetic retinopathy special place occupy normalization carbohydrate metabolism , because contributes to the progression of the disease. This happens by assigning hypoglycemic drugs. Normalization of the patient’s diet also plays an important role.

Treatment of diabetic retinopathy should be carried out jointly by an ophthalmologist and an endocrinologist. With timely diagnosis and complex treatment there is every chance to maintain vision and a full social and personal life.

The doctors

Medicines

Prevention of diabetic retinopathy

Prevention of retinopathy is to maintain normal blood sugar levels in diabetics, optimal compensation of carbohydrate metabolism, control blood pressure, correction of lipid metabolism. This allows you to reduce possible complications from the side of the eyes.

Proper nutrition and regular physical exercise have a positive impact on general state patients with diabetes mellitus. It is also important to have regular checkups with your eye doctor. Timely prevention of diabetic retinopathy and eye damage in diabetes mellitus is very important. Since in the later stages of the disease treatment is not effective. However, due to the fact that visual disturbances are not observed in the initial stages of retinopathy, patients seek help when extensive hemorrhages and changes in the central zone of the retina already occur.

Complications of diabetic retinopathy

The main complications of diabetic eye damage are traction retinal detachment , V emergence of hemophalmos , and secondary neovascular glaucoma , the treatment of which requires surgical intervention.

Diet, nutrition for diabetic retinopathy

List of sources

Vorobyova I.V., Merkushenkova D.A., Estrin L.G., Kalinina N.I., Ivanova D.P. Molecular mechanisms pathogenesis of diabetic retinopathy and maculopathy. // XI All-Russian School of Ophthalmology: collection scientific works. - M., 2012;
Balashevich L.I. Ocular manifestations of diabetes / L.I. Balashevich, V.V. Brzhesky, A.S. Izmailov and others; Ed. L.I. Balashevich. - St. Petersburg: Publishing house St. Petersburg MAPO, 2004;
Astakhov Yu.S., Shadrichev F.E., Lisochkina A.B. Diabetic retinopathy (patient management tactics) // Clinical ophthalmology. - M., 2004.

– a specific angiopathy that affects the vessels of the retina of the eye and develops against the background of a long course of diabetes mellitus. Diabetic retinopathy has a progressive course: in the initial stages there is blurred vision, veils and floating spots before the eyes; in later years a sharp decline or loss of vision. Diagnostics includes consultations with an ophthalmologist and diabetologist, ophthalmoscopy, biomicroscopy, visometry and perimetry, angiography of retinal vessels, and biochemical blood tests. Treatment of diabetic retinopathy requires systemic management of diabetes, correction metabolic disorders; in case of complications - intravitreal administration of drugs, laser photocoagulation of the retina or vitrectomy.

Causes and risk factors

The mechanism of development of diabetic retinopathy is associated with damage to the retinal vessels (blood vessels of the retina): their increased permeability, occlusion of capillaries, the appearance of newly formed vessels and the development of proliferative (scar) tissue.

Most patients with long-term diabetes mellitus have some signs of fundus damage. When diabetes lasts up to 2 years, diabetic retinopathy to varying degrees is detected in 15% of patients; up to 5 years – in 28% of patients; up to 10-15 years – 44-50%; about 20-30 years – in 90-100%.

The main risk factors influencing the frequency and rate of progression of diabetic retinopathy include the duration of diabetes mellitus, the level of hyperglycemia, arterial hypertension, chronic renal failure, dyslipidemia, metabolic syndrome, and obesity. The development and progression of retinopathy can be promoted by puberty, pregnancy, hereditary predisposition, and smoking.

Classification

Taking into account the changes developing in the fundus, non-proliferative, pre-proliferative and proliferative diabetic retinopathy are distinguished.

Elevated, poorly controlled blood sugar levels lead to damage to blood vessels in various organs, including the retina. In the non-proliferative stage of diabetic retinopathy, the walls of the retinal vessels become permeable and fragile, which leads to pinpoint hemorrhages and the formation of microaneurysms - local saccular dilatation of the arteries. Through the semi-permeable walls of the vessels, a liquid fraction of blood leaks into the retina, leading to retinal edema. If the central zone of the retina is involved in the process, macular edema develops, which can lead to decreased vision.

In the preproliferative stage, progressive retinal ischemia develops due to occlusion of arterioles, hemorrhagic infarctions, and venous disorders.

Preproliferative diabetic retinopathy precedes the next, proliferative stage, which is diagnosed in 5-10% of patients with diabetes. Contributing factors for the development of proliferative diabetic retinopathy include high myopia, carotid artery occlusion, posterior vitreous detachment, and optic nerve atrophy. At this stage, due to oxygen deficiency experienced by the retina, new vessels begin to form in it to maintain adequate oxygen levels. The process of retinal neovascularization leads to repeated preretinal and retrovitreal hemorrhages.

In most cases, minor hemorrhages in the layers of the retina and vitreous resolve on their own. However, with massive hemorrhages into the eye cavity (hemophthalmos), irreversible fibrous proliferation occurs in the vitreous body, characterized by fibrovascular adhesions and scarring, which ultimately leads to tractional retinal detachment. When the outflow pathways of the intraocular fluid are blocked, secondary neovascular glaucoma develops.

Symptoms of diabetic retinopathy

The disease develops and progresses painlessly and with few symptoms - this is its main insidiousness. In the non-proliferative stage, vision loss is not subjectively felt. Macular edema can cause a feeling of blurred vision and difficulty reading or doing close-up work.

In the proliferative stage of diabetic retinopathy, when intraocular hemorrhages occur, floating dark spots and a veil, which disappear on their own after some time. With massive hemorrhages into the vitreous body there is a sharp decrease or total loss vision.

Diagnostics

Patients with diabetes require regular examination by an ophthalmologist to identify initial changes in the retina and prevent proliferating diabetic retinopathy.

In order to screen for diabetic retinopathy, patients undergo visometry, perimetry, biomicroscopy of the anterior segment of the eye, biomicroscopy of the eye with a Goldmann lens, diaphanoscopy of eye structures, Maklakov tonometry, ophthalmoscopy under mydriasis.

The ophthalmoscopic picture is of greatest importance for determining the stage of diabetic retinopathy. In the non-proliferative stage, microaneurysms, “soft” and “hard” exudates, and hemorrhages are detected ophthalmoscopically. In the proliferative stage, the fundus picture is characterized by intraretinal microvascular abnormalities (arterial shunts, dilation and tortuosity of veins), preretinal and endoviteral hemorrhages, neovascularization of the retina and optic disc, fibrous proliferation. To document changes in the retina, a series of fundus photographs are taken using a fundus camera.

In case of opacities of the lens and vitreous body, instead of ophthalmoscopy, they resort to ultrasound of the eye. In order to assess the safety or dysfunction of the retina and optic nerve, electrophysiological studies are carried out (electroretinography, determination of CFSM, electrooculography, etc.). Gonioscopy is performed to detect neovascular glaucoma.

The most important method for visualizing retinal vessels is fluorescein angiography, which makes it possible to record blood flow in the choreoretinal vessels. An alternative to angiography is optical coherence and laser scanning tomography of the retina.

To determine risk factors for the progression of diabetic retinopathy, a study of blood and urine glucose levels, insulin, glycosylated hemoglobin, lipid profile and other indicators; USDG renal vessels, EchoCG, ECG, 24-hour blood pressure monitoring.

In the process of screening and diagnosis, it is necessary to earlier identify changes indicating the progression of retinopathy and the need for treatment to prevent decrease or loss of vision.

Treatment of diabetic retinopathy

Along with general principles treatment of retinopathy, therapy includes correction of metabolic disorders, optimization of control over glycemic levels, blood pressure, and lipid metabolism. Therefore, at this stage, the main therapy is prescribed by an endocrinologist-diabetologist and a cardiologist.

The level of glycemia and glucosuria is carefully monitored, and adequate insulin therapy for diabetes mellitus is selected; Angioprotectors, antihypertensives, antiplatelet agents, etc. are prescribed. Intravitreal steroid injections are performed to treat macular edema.

Patients with progressive diabetic retinopathy are indicated for laser coagulation of the retina. Laser photocoagulation makes it possible to suppress the process of neovascularization, achieve obliteration of vessels with increased fragility and permeability, and prevent the risk of retinal detachment.

There are several main techniques used in retinal laser surgery for diabetic retinopathy. Barrier laser coagulation of the retina involves the application of paramacular coagulates in a “lattice” pattern, in several rows, and is indicated for non-proliferative retinopathy with macular edema. Focal laser coagulation is used to cauterize microaneurysms, exudates, and small hemorrhages identified during angiography. In the process of panretinal laser coagulation, coagulates are applied over the entire retinal area, with the exception of the macular area; this method is mainly used at the preproliferative stage to prevent its further progression.

When the optical media of the eye are clouded, an alternative to laser coagulation is transscleral cryoretinopexy, based on cold destruction of pathological areas of the retina.

In the case of severe proliferative diabetic retinopathy, complicated by hemophthalmos, traction of the macula or retinal detachment, they resort to vitrectomy, during which blood and the vitreous itself are removed, connective tissue cords are dissected, and bleeding vessels are cauterized.

Prognosis and prevention

Severe complications of diabetic retinopathy can include secondary glaucoma, cataracts, retinal detachment, hemophthalmos, significant vision loss, and complete blindness. All this requires constant monitoring of patients with diabetes by an endocrinologist and ophthalmologist.

A major role in preventing the progression of diabetic retinopathy is played by properly organized control of blood sugar and blood pressure levels, and timely intake of hypoglycemic and antihypertensive drugs. Timely implementation of preventive laser coagulation of the retina helps to stop and regress changes in the fundus.

Diabetes mellitus is becoming one of the most common diseases. The disease can undermine the health of not only an adult, but also a child. Doctors associate this trend primarily with many factors that can affect the condition of the body. modern man: chronic fatigue, all kinds of stressful situations, excess weight, weight loss physical activity, prolonged sitting, unfavorable environment, as well as poor nutrition.

Dangerous prospect

Retinopathy in diabetes is not the only thing. As some studies show, by about 2025 a critical point will be reached. Scientists estimate that 300 million people will suffer from diabetes. And this is 5% of the entire world population.

Features of diabetes mellitus

To prevent retinopathy from developing quickly in diabetes, you need to know how to prevent it. This requires an understanding of how the disease works. The main sign of diabetes is an increase in the patient's blood sugar level. U healthy person The cells of the pancreas produce the hormone insulin. It is this substance that regulates metabolic processes, primarily sugar, proteins and fats.

In diabetes mellitus, insufficient insulin is produced. As a result of this, disturbances occur not only in terms of metabolism. Blood sugar rises. The cells of the body are unable to function normally under such conditions.

Insulin deficiency leads to disturbances in fat metabolism, as well as to the accumulation of cholesterol. This substance gradually accumulates on the walls of blood vessels and leads to dire consequences. Diabetes mellitus most often affects the eyes, kidneys, heart, visual apparatus, as well as blood vessels located in the lower extremities.

When does retinopathy occur in diabetes mellitus?

5-10 years after the first symptoms of diabetes mellitus, a person develops diabetic retinopathy. For type 1 disease this phenomenon proceeds rapidly. Retinopathy develops quickly and becomes proliferative. If a patient has type 2 diabetes mellitus, then all changes are mostly observed in the central zone of the retina. Maculopathy often develops. It is usually cystic and leads to deterioration of central vision.

Why does diabetes mellitus and related diseases occur?

Several main reasons have been identified why diabetes mellitus develops. By avoiding further aggravation of the disease, you can prevent the development of retinopathy. Among the main reasons:

Obesity.
Hereditary predisposition.
Diseases of the pancreas that cause changes in beta cells, such as cancer, pancreatitis, and so on.
Viral infections, including influenza, epidemic hepatitis, chickenpox, rubella and so on. Such ailments are something of a trigger for those who are at risk.
Nervous stress.

Is it possible to immediately diagnose retinopathy?

Retinopathy in diabetes mellitus is not diagnosed immediately, since quite complex processes occur in the patient’s body. Often the disease becomes noticeable only after certain complications appear. Statistics show that retinopathy in type 1 diabetes is present in almost 99% of all patients.

This disease is serious complication. Retinopathy primarily affects the vessels located in the retina directly in eyeball. A complication occurs in more than 90% of all patients with diabetes. The main symptom of the disease is deterioration in visual acuity and disturbances, due to which a person ceases to see normally. Diabetes mellitus most often causes people to go blind. It is possible to identify the first signs of retinopathy. To do this, you need to undergo a thorough examination by ophthalmologists.

Diabetic retinopathy: symptoms

This disease occurs mostly without obvious symptoms. In the early stages, the patient does not feel problems with vision and does not notice a decrease in its acuity. Retinopathy in diabetes mellitus becomes apparent only after hemorrhage occurs inside the eye. At this moment, the patient develops a continuous veil and dark floating spots. After some time, these signs completely disappear.

However, the hemorrhage does not go unnoticed for the patient. As a result of such a disorder, complete loss of vision can occur. After all, cords begin to form inside, which can lead to retinal detachment.

In addition, there is swelling of the central sections responsible for a person’s ability to read and observe small objects. In such cases, the veil returns to the eyes. Reading, working at close range, as well as sewing, knitting and embroidery become almost impossible.

Classification of retinopathy

Diabetic retinopathy, the symptoms of which are described above, has several varieties. Classification of this disease was created in 1992. It has been approved by the World Health Organization. This classification is still in effect. Retinopathy can be:

Non-profiled. This is peculiar pathological change occurring in the retina of the eye. It usually manifests itself as hemorrhages, microscopic aneurysms, the shape of which is dark spots or a dot.
Preproliferative. Similar retinopathy in diabetes mellitus, a photo of which can be seen below, is a venous anomaly. They have a tortuous contour and loops, a significant amount of exudates. Often with this disorder, a large number of large hemorrhages occur.
Proliferative. In this case, there is neovascularization of the disc, which is located in optic nerve. In this case, hemorrhage occurs in the vitreous body. As a result, fibrous tissue forms in the damaged area. Newly created vessels are fragile and have very thin walls. It is in them that repeated hemorrhages are observed. Vessels that form in the iris of the eye often lead to secondary glaucoma.

Stages of retinopathy

What is retinopathy in diabetes mellitus? The stages of this disease are determined by their characteristic features. There are three periods of the disease:

Easy stage. This period is typical for non-proliferative retinopathy. This is the most early stage diseases. During this period, microaneurysms develop - these are peculiar swellings in the form of balls that form in the small vessels of the retina.
Moderate stage. As the disease progresses, there is a blockage of blood vessels that are necessary for normal nutrition.
Difficult stage. With this disease, a large number of blood vessels are clogged. In this case, insufficient blood flow is observed in the retina. At this stage, the body receives signals that it is necessary to create new vessels to restore normal tissue nutrition.

Non-proliferative and proliferative retinopathy

Non-proliferative retinopathy in diabetes mellitus is characterized by the formation of an aneurysm in the central zone. It can also occur near large veins that run through the layers of the retina. In this case, exudative foci are noted in the fundus. As a rule, they have a white or yellow tint, as well as unclear boundaries. With this disease, there is swelling of the retina, located in the central region, as well as in the area of the central and larger vessels. This phenomenon is the main symptom of non-proliferative retinopathy in diabetes mellitus.

As for the proliferative type of the disease, this is the latest stage of the disease. Due to the fact that the retina does not receive enough nutrition, new vessels with fragile and thin walls begin to form. They are often called anomalous. Such vessels grow along the retina and also cover a significant part of the vitreous body located inside the eye. They are not capable of damaging vision, but are very fragile. Blood usually leaks from them. As a result, visual impairment occurs, which has serious consequences. Often the disease leads to complete blindness.

Retinopathy in type 2 and type 1 diabetes is treated completely differently. After all, their symptoms are not the same. In some cases, the disease can be cured completely without surgical intervention fails. As a rule, treatment of the disease is carried out comprehensively. Before prescribing treatment, the patient should be examined not only by an ophthalmologist, but also by an endocrinologist. If the disease is in the second or third stage, then taking medications will not be enough. In such a situation, laser photocoagulation of the retina is required. This is the most effective method.

Retinopathy in diabetes mellitus, the symptoms of which can appear only at the last stage, is a complex disease. Therapy is carried out with strict adherence to insulin therapy, as well as with the preparation proper diet for the patient. The patient is prohibited from consuming large quantities of animal fats. They are usually replaced by herbal products. Easily digestible carbohydrates should be excluded from the diet. With this disease they are very harmful.

Products and preparations

Treatment of retinopathy in diabetes mellitus - difficult process which requires patience. First of all, it is worth creating a diet for the patient. Experts recommend eating foods that contain lipotropic components that are beneficial to the eyes. The patient's menu should include broccoli, black currants, blueberries and viburnum, hot and sweet peppers, Brussels sprouts, and sea cabbage. In addition, the diet should contain products such as new potatoes, dairy products, liver, fish fat and so on.

In addition, it is worth taking vitamin complexes. Group B drugs are very useful for patients with diabetes. They can be taken not only orally, but also parenterally.

Vitamins such as E, P and C have a positive effect on the walls of blood vessels. They have a protective effect. Effective angioprotective drugs are Doxium, Dicinon, Anginin.

Medicines should be taken only as prescribed by specialists. Treatment of retinopathy in diabetes mellitus is not only the use of medications. This disease requires regular and thorough ophthalmological examinations. In addition, it is necessary to undergo regular tests to determine blood sugar levels.

Herbal preparations from the pharmacy

So, retinopathy in diabetes mellitus, the symptoms of which become more obvious in the later stages, is a disease that is very difficult to cure. At the pharmacy you can buy drugs for plant based. Here is a list of the most effective:

"Tanakan." This drug is prescribed quite often. This medicine is made from a plant such as ginkgo biloba. The drug should be taken with meals three times a day, one tablet. The course is at least three months.
"Neurostrong". This is another effective medicine. It is made from several components: blueberries, B vitamins, ginkgo biloba and lecithin. The drug can improve blood circulation, ensuring normal respiration for cells. This eliminates the risk of hemorrhages and blood clots. Neurostrong is prescribed up to 4 times a day, one tablet at a time.
"Dibikor". Retinopathy in diabetes mellitus recedes before this drug. How to treat a disease with this remedy? The drug is prescribed in half a gram up to two times a day. The medicine should be taken approximately 20 minutes before morning and evening meals. Course - 6 months. The product can improve metabolism and saturate tissue cells with useful components.

Aloe for illness

Retinopathy due to diabetes folk remedies which is allowed may cause serious consequences. Alternative medicine drugs are usually used to prevent the disease. If the symptoms of the disease have not yet appeared or the disease is at an early stage, then you can try aloe-based preparations.

This plant has unique properties and is used to treat many problems. In order to prepare the medicine, you will need aloe that is no more than three years old. The plant should be carefully examined and healthy and fleshy leaves should be selected. They should be washed thoroughly and then wrapped in paper. It's better to use parchment. The resulting raw materials should be kept for some time on the bottom shelf of the refrigerator. To be more precise, it will take 12 days. Only after this can the aloe leaves be crushed. To do this, it is better to use a meat grinder or blender.

The resulting mass should be squeezed out using gauze. The juice must be filtered using a fairly thick cloth, and then placed on the fire and brought to a boil. The resulting composition should be cooked for about three minutes.

You cannot store prepared juice for a long time. The drug begins to lose its properties very quickly. Therefore, it is better to prepare the product in this way just before taking it. You need to take aloe juice three times a day, a teaspoon half an hour before meals. In addition, the drug can be instilled into the eyes. This should be done at night. A few drops will be enough. However, you should be careful when instilling. Such therapy should be carried out only with the permission of the attending physician.

Infusions and juices

How else can retinopathy be treated in diabetes? Treatment with folk remedies is usually prescribed to maintain the patient’s condition, as well as for prevention. If the disease is at an initial stage, then similar drugs can stop him further development. In alternative medicine, various herbal infusions are used.

One of the effective ones is a preparation based on calendula. To prepare it, you need to chop the flowers of this plant and pour hot water. Half a liter of boiling water requires three teaspoons of raw materials. The container with the grass must be wrapped and infused for three hours. The finished mixture should be strained well. You should take the calendula infusion up to four times a day, ½ cup. The same alternative medicine drug can be used for eye drops.

An infusion prepared with blueberries also has a good effect. To prepare this medicine you need to pour a glass of boiling water over a tablespoon of berries. The drug should be infused for an hour. The finished product should be drunk a day before.

Juices from various berries are also beneficial. After all, they contain a large number of useful components. To combat retinopathy in diabetes mellitus, you can drink a drink made from lingonberries. It is worth noting that daily consumption of such juice helps to overcome even caretinopathy at the initial stage.

Amazing collection

To eliminate retinopathy in diabetes mellitus, you can use various preparations. If desired, you can prepare such a remedy yourself. Here is one of effective recipes alternative medicine.

For preparation you will need: chopped burdock root, chopped leaves, as well as willow bark, knotweed, bearberry, nettle, Walnut, birch and mint leaves. The components must be taken in equal proportions. In a deep container, combine all the ingredients of the collection and then mix. A tablespoon of the resulting mixture should be brewed with half a liter of boiling water. The drug should infuse for an hour. After this you need to strain it. This collection should be consumed in half a glass, preferably before meals. The course is at least 3 months. The effect will be achieved if you use the product without interruption. Now you know what retinopathy is in patients with diabetes. Do not forget that any therapy using unconventional methods should not be carried out without consulting specialists. Otherwise it can only do harm.