How and with what is diabetic retinopathy treated. What is retinopathy in patients with diabetes? Retinopathy in diabetes mellitus: symptoms, treatment with folk remedies

Diabetic retinopathy. Diabetes eyes

Diabetes - serious disease, often leading to disability and death. Its treatment is one of the priorities of modern world medicine. According to the World Health Organization, 3% of the world's population has diabetes mellitus and there is a clear increase in the spread of the disease. Currently, the total number of people with diabetes in the world has exceeded 100 million people, their number increases annually by 5-7% and doubles every 12-15 years. The number of people with diabetes in Russia is approaching 10 million people.

Diabetic retinopathy (Diabetes of the eye), a specific late vascular complication of diabetes mellitus, is the leading cause of blindness among people of working age in developed countries. It accounts for 80-90% of all visual disability caused by diabetes mellitus (Kohner E.M. et al., 1992). Blindness in patients with diabetes mellitus occurs 25 times more often than in the general population (WHO, 1987). Pathological changes in the fundus of the eye during diabetic retinopathy in most cases occur 5-10 years from the onset of the disease and are observed in 97.5% of cases of all diabetic patients. The most severe form of the lesion is proliferative diabetic retinopathy (PDR), which usually leads to disability. According to a number of authors, proliferative eye retinopathy develops in more than 40% of patients. Retinal vascular complications occur in both patients with insulin-dependent and non-insulin-dependent diabetes mellitus.

Symptoms of diabetic retinopathy

Diabetic retinopathy of the retina is painless and early stages disease, the patient may not notice a decrease in vision. The occurrence of intraocular hemorrhages is accompanied by the appearance of a veil and floating dark spots, which usually disappear without a trace after some time. In most cases, intraocular hemorrhages lead to rapid and complete loss vision (Fig. 2) as a result of the formation of vitreretinal cords in the vitreous body, followed by tractional retinal detachment. Development of edema central departments The retina (see structure of the eye), responsible for reading and the ability to see small objects, can also cause the sensation of a veil in front of the eye (Fig. 3). It is common to experience difficulties when performing close-up work or reading.

Preventing blindness in diabetes

Most patients with a disease duration of more than 10 years have some signs of eye damage due to diabetes mellitus. Careful monitoring of blood glucose levels, compliance necessary diet and management healthy image lifespan can reduce, but do not eliminate, the risk of blindness from eye complications of diabetes.

Risk factors for developing diabetic retinopathy:

• duration of diabetes
• uncompensated diabetes mellitus (poor glycemic control),
• pregnancy,
• genetic predisposition.

The surest way to prevent blindness is strict adherence frequency of fundus examinations by an ophthalmologist.

Necessary frequency of examinations of patients with diabetes mellitus by an ophthalmologist.

TIME OF DIABETES ONset	DATE FOR FIRST INSPECTION
Age up to 30 years	After 5 years
Age over 30	When diagnosing
Pregnancy	First trimester*
INSPECTION RESULTS	FREQUENCY OF REPEATED INSPECTIONS
Lack of DR	Annually
Nonproliferative diabetic retinopathy	4-6 months
Proliferative, preproliferative DR or diabetic macular edema	Laser treatment is prescribed, the frequency between stages of which ranges from 2-3 weeks to 4-6 months.

Laser treatment is prescribed, the frequency between stages of which ranges from 2-3 weeks to 4-6 months.

* - during pregnancy, repeated examinations are carried out every trimester, even if there are no changes in the fundus of the eye.

If there is an unexpected decrease in visual acuity or the appearance of any other vision complaints in diabetic patients, an examination should be carried out immediately, regardless of the timing of the next visit to the ophthalmologist.

Only a specialist can determine the degree of diabetic damage to the organ of vision.

Risk factors for significant vision loss

Neovascular glaucoma- This is secondary glaucoma caused by the proliferation of newly formed vessels and fibrous tissue in the angle of the anterior chamber and on the iris. During its development, this fibrovascular membrane contracts, which leads to the formation of large goniosynechiae and an intractable increase in intraocular pressure. Secondary glaucoma is relatively common, with pronounced development difficult to treat and leads to irreversible blindness.

Diagnosis of diabetic lesions of the organ of vision

Diagnosis of diabetic retinopathy should be carried out using modern high-precision equipment and include the following studies:

• determination of visual acuity, which allows you to determine the condition of the central region of the retina,
• visual field examination (computer perimetry) to determine the condition of the retina in the periphery,
• anterior segment examination eyeball(biomicroscopy), which allows you to determine the condition of the iris and lens,
• examination of the anterior chamber angle (gonioscopy),
• visual field examination (computer perimetry),
• measurement of intraocular pressure (tonometry).

If the level of intraocular pressure allows, then further studies are carried out with a medically dilated pupil.

• biomicroscopy of the lens and vitreous body,
• electrophysiological research methods to determine functional state optic nerve and retina,
• ultrasonography(scan) of the organ of vision to determine the condition of the vitreous body. This study is especially important in the presence of opacities in optical media, in which fundus ophthalmoscopy is difficult.
• examination of the fundus (ophthalmobiomicroscopy), which allows us to identify the condition of the retina and its relationship with the vitreous body, determine qualitative changes in the retina and their localization. Ophthalmic biomicroscopy should be carried out with mandatory registration and photographing of the data obtained, which makes it possible to obtain documentary information about the condition of the fundus, the degree of retinopathy and reliable results of the effectiveness of the prescribed treatment.

The study reveals changes in the retina that indicate the presence of retinopathy with a risk of progressive damage and blindness, indicating the likelihood of an unfavorable outcome over the next year.

The results of these studies will allow our specialist to recommend the treatment you need to prevent vision loss.

Basic principles of treatment of diabetic retinopathy

At all stages of diabetic retinopathy, treatment of the underlying disease should be carried out, aimed at correcting metabolic disorders. According to many clinical and experimental studies, there is a clear correlation between the degree of glycemic compensation and the development of diabetic retinopathy. A study completed in 1993 in the USA on the influence of the degree of control of metabolic disorders in patients with diabetes mellitus on the development of microvascular complications showed that the better glycemic control was, the lower the risk and incidence of diabetic retinopathy. Therefore, at present, the main way to prevent diabetic retinopathy is to maintain long-term and as stable compensation of diabetes mellitus as possible. Strict glycemic control and adequate therapy diabetes mellitus should be organized as early as possible from the onset of the disease.

Use in medicinal or for preventive purposes to influence diabetic changes in the fundus of such angioprotectors as Trental, Divascan, Doxium, Dicinone, Anginin are considered ineffective, especially against the background of unsatisfactory compensation carbohydrate metabolism. For this reason, in the health care system of most countries with medical insurance organizations conservative therapy diabetic retinopathy is not carried out and the generally accepted methods of treating patients with DR are systemic management of diabetes, laser photocoagulation of the retina and surgical treatment of ocular complications of diabetes.

– 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: initial stages there is blurred vision, veils and floating spots before the eyes; in later cases there is a sharp decrease 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 and correction of 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 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 vascular damage 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 it leaks into the retina. liquid fraction blood, 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 myopia high degree, occlusion of the carotid arteries, posterior vitreous detachment, 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 appear before the eyes, which disappear on their own after some time. With massive hemorrhages into the vitreous body, a sharp decrease or complete loss of vision occurs.

Diagnostics

Patients with diabetes need regular inspection 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.

Nai higher value An ophthalmoscopic picture is used to determine 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 visualization of 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; Ultrasound of 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 on 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 are prescribed, antihypertensive drugs, antiplatelet agents, etc. In order to treat macular edema, intravitreal steroid injections are performed.

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.

IN laser surgery retina treatment for diabetic retinopathy, several basic methods are used. 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.

Proper control of blood sugar levels plays a major role in preventing the progression of diabetic retinopathy and blood pressure, 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.

»» No. 11-12 "99 »» New medical encyclopedia Diabetes mellitus (DM) is a serious disease, often leading to disability and death. Its treatment is one of the priorities of modern world medicine.

According to WHO, currently the total number of people with diabetes in the world has exceeded 100 million people (3% of the world's population). It increases annually by 5-7% and doubles every 12-15 years.

The number of people with diabetes in Russia is about 10 million people.

Patients with diabetes, compared with non-diabetic individuals, have a high risk of:

• development of ischemic disease (3-5 times higher);
• kidney damage (noted in 1 out of 6 patients with diabetes);
• 25 times higher risk of developing blindness;
• the incidence of gangrene of the feet is high (1 case per 200 patients).

Leonid Iosifovich Bolashevich - director of the St. Petersburg branch of the MNTK "Eye Microsurgery", head. Department of Ophthalmology St. Petersburg MAPO, academician of the Laser Academy of Sciences of the Russian Federation, professor, dr med. sciences

Alexander Sergeevich Izmailov - head. Department of Laser Surgery, St. Petersburg Branch of the MNTK "Eye Microsurgery", Ph.D. honey. sciences

Diabetes mellitus is main reason development of blindness in middle-aged people.

Diabetic retinopathy (DR) is a highly specific lesion of the retinal vessels, equally characteristic of both insulin-dependent and non-insulin-dependent diabetes. There are several forms of diabetic retinopathy:

Non-proliferative (background) DR is the first stage of diabetic retinopathy, which is characterized by occlusion and increased permeability small vessels retina (microvascular angiopathy). Background retinopathy is characterized by a long-term course with complete absence any visual impairment.

Preproliferative DR is a severe nonproliferative retinopathy that precedes the onset of proliferative retinopathy.

Proliferative DR develops against the background of non-proliferative DR, when capillary occlusion leads to the emergence of large areas of impaired blood supply (nonperfusion) to the retina. The “starving” retina secretes special vasoproliferative substances designed to trigger the growth of newly formed vessels (neovascularization). Neovascularization in the body usually serves a protective function. In case of injury, this helps accelerate wound healing, and after surgical transplantation, it promotes good engraftment. In tumors, osteoarthritis and diabetic retinopathy, neovascularization has an adverse effect.

Diabetic macular edema is a lesion of the central parts of the retina. This complication does not lead to blindness, but may cause loss of the ability to read or distinguish small objects. Macular edema is more often observed with the proliferative form of diabetic retinopathy, but can also be observed with minimal manifestations nonproliferative DR. In the initial stages of development of macular edema, visual impairment may also be absent.

Frequency of examinations of patients with diabetes mellitus by an ophthalmologist

* - during pregnancy, repeated examinations are carried out every trimester, even if there are no changes in the fundus of the eye

Natural course of the proliferative process

Newly formed vessels have a wall consisting of a single layer of cells and are characterized by rapid growth, massive transudation of blood plasma and increased fragility, which leads to intraocular hemorrhages varying degrees gravity. Small hemorrhages in the retina and vitreous body undergo spontaneous resorption, massive hemorrhages in the eye cavity (hemophthalmos) lead to irreversible fibrous proliferation in the vitreous body. Severe hemophthalmos is not the only cause of vision loss. In the development of blindness, the leakage of protein fractions of blood plasma from newly formed vessels, which trigger the processes of scarring of the retina and vitreous body, is of much greater importance. The gradual reduction of these fibrovascular formations, usually localized along the temporal vascular arcades and on the optic nerve head, causes the development of tractional retinal dissection (retinoschisis), which, when spreading to the macular area, affects central vision.

Reduction of fibrous tissue increases the likelihood of rupture of newly formed vessels, leading to relapses of hemophthalmos. This further enhances the processes of scarring in the vitreous body, which ultimately may be the cause of the development of rhegmatogenous retinal detachment. In this case, rubeosis of the iris usually develops; rapid leakage of blood plasma from the newly formed vessels of the iris leads to blockage of the outflow tract. intraocular fluid and the development of secondary neovascular glaucoma. This pathogenetic chain is quite arbitrary and describes the most unfavorable scenario. The natural course of proliferative DR does not always end in complete blindness; at any stage, the development of proliferative retinopathy can spontaneously abort. Although vision loss is common, residual visual function can vary widely.

How to prevent blindness in diabetes?

Most diabetic patients with a disease duration of more than 10 years have some signs of retinal damage. Careful monitoring of blood glucose levels, proper diet, and a healthy lifestyle can reduce the risk of blindness from eye complications of diabetes. However, the surest way to prevent blindness is strict adherence to the frequency of fundus examinations by an ophthalmologist (table).

What are the symptoms of diabetic retinopathy?

Retinal damage is painless; in the early stages of diabetic retinopathy and macular edema, the patient may not notice decreased vision. The occurrence of intraocular hemorrhages is accompanied by the appearance of a veil and floating dark spots in front of the eye, which usually disappear without a trace after some time. Massive hemorrhages into the vitreous lead to complete loss of vision. The development of macular edema can also cause a blurry sensation in front of the eye. Difficulty doing close work or reading.

How to treat diabetic retinopathy?

Since retinal damage in diabetes is secondary, important has systemic management of the underlying disease - careful monitoring of blood glucose levels, blood pressure, and kidney function. The study Diabetes Control and Complications Research Group - a group for the study of compensation for diabetes and its complications (USA), showed that compared with traditional therapy Intensive management of diabetes reduces the likelihood of developing DR by 74% and the occurrence of proliferative retinopathy by 47%.

Laser treatment is performed on an outpatient basis and is the most widely used treatment for diabetic retinopathy and macular edema. The essence of laser exposure comes down to:

Destruction of zones of retinal hypoxia, which is a source of release of growth factors of newly formed vessels;

Increased direct supply of oxygen to the retina from the choroid;

Thermal coagulation of newly formed vessels.

In preproliferative or proliferative DR, laser burns are applied throughout the entire retina, excluding its central parts (panretinal laser coagulation). Newly formed vessels are exposed to focal laser irradiation. The surgical method is especially highly effective when treatment is started early, long-term preventing blindness in almost 100% of cases. The degree of diabetes compensation does not have a noticeable effect on treatment results. In advanced situations, its effectiveness is greatly reduced. In the case of diabetic macular edema, the central parts of the retina are exposed to laser radiation. The longevity of the treatment effect is largely determined by the systemic status of the patient.

Surgical treatment (vitrectomy) is indicated for massive intraocular hemorrhages or advanced proliferative retinopathy. The essence of vitrectomy is to remove blood clots, clouded portions of the vitreous body and fibrovascular strands on the surface of the retina from the eye cavity. Aspiration of the vitreous body is performed as completely as possible. If possible, the posterior hyaloid membrane, located between the retina and the vitreous body and playing important role in the development of proliferative retinopathy.

Conservative treatment. With hemophthalmia, the patient is recommended to spend maximum time sitting with both eyes closed. This simple method promotes thrombosis of the bleeding vessel and sedimentation of blood elements in lower sections cavities of the eye under the influence of gravity. After a sufficient increase in the transparency of the optical media of the eye, laser treatment of diabetic retinopathy is performed. If within 1 month. this does not happen, then vitrectomy is performed. Drug therapy diabetic retinopathy and hemophthalmia is one of the most controversial areas of modern ophthalmology. On the one hand, a large amount of research has been conducted on this issue and an active search for new therapeutic drugs continues. On the other hand, today there are no medications whose effectiveness in the treatment of diabetic retinopathy has been proven. In modern foreign guidelines and manuals on the management of diabetic retinopathy and hemophthalmia, their methods drug treatment either not considered or mentioned briefly in the section on promising developments. For this reason, in the health care system of most countries with medical insurance organizations, conservative therapy for diabetic retinopathy is not carried out and the generally accepted methods of treating patients with DR are systemic management of diabetes, laser coagulation and surgery ocular complications of diabetes. Traditionally performed in many eye hospitals in Russia conservative treatment patients with DR is not only an example of wasteful spending budget funds, but also one of the main reasons for late referral of patients for laser treatment.

Diabetic retinopathy is a complication of the underlying disease, which can manifest itself in a patient due to poor treatment and non-compliance. preventive measures. In addition, the occurrence of pathology occurs if the diagnosis occurs too late and an advanced form of the disease is present. With this pathology, damage to the retina of the eye is noted, which can lead to. Vitamin complexes do not prevent the development of this defect.

The exact reason contributing to the development pathological process, could not be found. What is known is that the problem occurs in patients with diabetes. However, there are certain risk groups, which often include a large part of the population. Retinopathy can occur in the following categories of people:

• those who do not follow the rules of a healthy lifestyle and have many bad habits;
• elderly patients suffering from various types of diabetes;
• having problems with kidney function;
• patients with one of their relatives having diabetes mellitus;
• having high level glucose in the blood, which lasts for a long time;
• with surges in blood pressure, characterized by constant high blood pressure levels;
• women with diabetes during pregnancy.

At high concentration glucose, the absence of vitamin in the body causes damage to small vessels that help blood get to the eye area. In addition, the situation is aggravated by the behavior of the patient, who may regularly smoke or drink alcoholic beverages. Even periodic consumption of alcoholic beverages contributes to the development of the pathological process.

For this reason, you need to constantly monitor your blood sugar so as not to subsequently lose your ability to see. With timely reduction of sugar levels and stabilization of blood pressure, patients can resist the development of diabetic retinopathy.

Symptoms and diagnosis of pathology

For diabetic retinopathy, the symptoms are:

• drop in visual acuity, sometimes to a critical level;
• noticeable eyes that occur regularly;
• the image may take on blurry silhouettes, interference and circles appear before the eyes;
• discomfort in the eye area, which can pass and manifest itself independently for no apparent reason.

First of all, it is worth noting that patients suffering from diabetes should regularly check their visual acuity and eye condition with an ophthalmologist. It is better that it becomes the norm to visit the doctor at least once every six months. To obtain information about the patient’s condition, the ophthalmologist performs the following manipulations:

• measurement of intraocular pressure;
• viziometry;
• examination and examination of the eyelid and body of the eyeball;
• conducting biomicroscopy of the eye (anterior part).

If the patient has good intraocular pressure, a number of other studies can be performed. After the dilation of the pupil is noted, do:

• examination of the retina and vitreous cavity using a slit lamp;
• photographing the fundus using a camera;
• biomicroscopy of the vitreous body and lens;
• visual inspection of the optic nerve head and macular area.

Such measures help to identify the disease at an early stage, when it is possible to relieve the pathology without surgical intervention. There are eye drops that help patients avoid the occurrence of pathology in a timely manner.

Such vitamin preparations and complexes are prescribed and selected individually by the doctor.

However, without diagnosis and proper treatment, the condition will worsen over time, and the stages of diabetic retinopathy will be identified by pronounced symptoms.

But only an ophthalmologist can determine them; it is impossible to independently determine the degree of development of the disease, due to the lack of knowledge in this area and lack of specialized equipment for inspection.

Classification of the disease

The classification of diabetic retinopathy is used for convenience in prescribing treatment. If you rely on the Kochner and Porta table, then identifying the stages is quite easy. Ophthalmologists believe that without determining the extent of the disease, difficulties will arise in further treatment. The following stages are distinguished:

1. Non-proliferative diabetic retinopathy. This degree characterized by the formation of pathological changes in the retina of the eye. Visual examination may reveal small aneurysms, hemorrhages, retinal swelling and exudative lesions. In principle, the pathogenesis of the disease is extensive, therefore there are enough specific manifestations.
2. Hemorrhages can be in the form of dots or round spots, sometimes they take on a streak-like appearance. Soft and hard exudates are clearly visible in the central area of ​​the fundus. Important, that this pathology always accompanied by swelling.
3. Preproliferative diabetic retinopathy. At this stage, the patient has clearly visible IRA and venous anomalies. There are quite a lot of exudates, some of which resemble cotton wool in consistency. The pronounced severity of changes of this type indicates possible risk manifestations of proliferation.
4. Proliferative diabetic retinopathy. Proliferation occurs in two types at once; it can be fibrous or vascular. Pathology always begins to form in the optic disc area. There may be manifestations based on the location of the vascular arcades. In this case, there are no restrictions, since the process often involves other areas of the fundus. Proliferative retinopathy suggests that defective walls of newly formed vessels will produce frequent hemorrhages. This condition can be provoked by detachment of the walls of the vitreous body. Provided that this condition continues to develop and the process is not stopped in any way, complete retinal detachment is possible.

According to doctors, it is proliferative diabetic retinopathy that is highly dangerous. There is a risk of complete loss of vision, without further possibility of recovery.

The pathological process can be long-term, sometimes the condition lasts for years. It is noted that when patients come to see an ophthalmologist, they only complain about vision problems in one eye.

Without suspecting that they actually have a more serious pathology. Compounding the picture is the fact that some people believe that they lack a vitamin in their body that helps maintain normal vision. And so they try to treat themselves.

Prevention and its directions

Given the fact that the disease affects people with diabetes, it is imperative to take medications that help control glucose. In addition, it will not be a bad idea to monitor your diet, because due to foods and meal schedules, glucose levels can be greatly increased.

To improve general health, the patient should avoid excessive consumption of carbohydrates. It is best if fruits sometimes predominate in the daily diet. Fresh vegetables also help diabetics, the main thing is not to overdo it.

Experts note that foods that contain a sufficient amount of proteins and natural fats are suitable for proper nutrition. None auxiliary drugs will not replace this, since some complexes are of synthetic origin.

If there are sharp jumps in blood pressure, then you need to visit a therapist. The doctor will prescribe therapy to maintain normal levels. To avoid relapse of the disease, blood pressure should not be higher than 130/80.

If we consider products, blueberries contain a large amount of vitamins, which have the most beneficial effect on the visual system and are directly responsible for visual acuity. Diabetic retinopathy, the stages of which differ in their manifestations, requires a specific schedule for visiting an ophthalmology clinic:

• regardless of the subtype of the disease, visits occur every 12 months;
• twice a year if non-proliferative retinopathy is diagnosed (if present) macular spot this is the minimum number of visits);
• the thermal stage has no restrictions, since the doctor sets a date for the visit depending on the patient’s condition;
• proliferative diabetic retinopathy requires frequent visits, the patient should be seen every 3 months;
• Patients who have preproliferative retinopathy visit 4 times a year.

If the doctor's instructions are constantly followed, the patient will not suffer from blindness. Today, eye drops are considered quite effective in the fight against this pathology, but a guaranteed recovery from the fact that they are prescribed may not occur.

Is vitrectomy necessary for retinal pathology?

Diabetic retinopathy requires regular monitoring of blood sugar. In addition, you need to undergo an examination by an ophthalmologist and monitor possible manifestation signs of the disease. Due to the lack of proper behavior, damage to the vitreous body often overtakes the patient again. To combat this situation, vitrectomy is proposed.

Understanding what diabetic retinopathy is, you should also know what vitrectomy is. The use of vitrectomy is required in cases where the disease has become severe.

The patient has extensive hemorrhages in both eyes. Surgery will require removal blood clots and affected parts of the vitreous body. Fibrovascular cells need to be removed from the retinal area.

The ophthalmologist sucks out the vitreous fluid. This requires carefully removing part of the hyaloid membrane (only the back). It is located in the area between the vitreous body and the retina of the eye.

It is this removed area that plays a huge role in the development of the pathological process. Indications for surgical intervention of this type are the following symptoms:

• advanced or old changes of fibrous type in the vitreous cavity;
• frequent and abundant hemorrhages in the retina of the eye, which can be visualized for a long time (sometimes up to six months);
• traction type.

Experts note that if a patient’s glycated hemoglobin level is above 10%, then laser therapy cannot be postponed. Treating this condition in other ways is quite dangerous, as is waiting until the moment when glucose normalizes in the bloodstream.

Lack of support medical care implies a risk of blindness for the patient. Conducted laser coagulation allows you to stabilize the situation, there is a slow decrease in blood glucose levels.

Laser treatment for retinopathy

For diabetic retinopathy, treatment should be aimed at relieving the underlying problem. The doctor takes all measures to help normalize blood glucose levels. In addition, therapeutic therapy is carried out that will help stabilize blood pressure and improve kidney function.

One of the most common types of treatment for the disease is laser therapy. In order to perform the manipulation, hospitalization is not required; all procedures can be performed on an outpatient basis. To provide the patient qualified assistance, several steps are required:

• the retina of the eye is treated with a laser at the site of localization of foci of the formation of new vessels;
• an increase in the amount of oxygen entering the retina from the choroid;
• renewed vessels are treated using thermal coagulation.

When retinopathy is treated using this method, the laser coagulant must be applied to the retinal area of ​​the eye, bypassing the central area. In parallel with this manipulation, focal laser irradiation is required to treat new vessels.

Treatment of diabetic retinopathy using a similar technique will achieve the most effective results. This is especially noticeable if the patient had an early stage of PDR, then blindness will definitely not occur.

Retinal cauterization involves regular examination by an ophthalmologist to observe the pathological area. 30 days after laser treatment, the patient must come for the first appointment.

Sometimes for prevention or speedy recovery eye drops are prescribed. Starting from individual characteristics patient, the ophthalmologist sets a date for the next visit. If there are no manifestations of the formation of complications, then a second appointment will take place after 2 months.

Some people get scared when the first time after laser treatment they notice that their vision has deteriorated. However, the symptoms are temporary; in the future, stabilization of the condition and elimination of unpleasant symptoms are expected.

Most cases involve laser therapy without the appointment of additional medical procedures. Provided that a re-examination has shown recurrent retinal lesions, the ophthalmologist conducts another laser treatment session. There are exceptions when up to 5 procedures are required for recovery.

Patients with diabetes need to be very sensitive to their health. After diabetic retinopathy has been treated and vision restored, infectious and viral diseases become destructive. They are the ones that provoke a relapse, which means that after suffering from the disease you should not use various drugs, but seek help from a professional.

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Among the complications that occur in people suffering from both type 1 and type 2 diabetes, diabetic retinopathy is considered the most serious and dangerous. The term "diabetic retinopathy" means impairment of visual perception due to damage to the blood vessels of the eyes, leading to a decrease and sometimes complete loss of vision. In type I diabetes, with a history of the disease of about 20 years or more, visual complications are observed in 85% of patients. When type II diabetes is diagnosed, approximately 50% already have such disorders.

Classification

Depending on the stage of the disease, the nature pathological changes in the vessels, as well as the tissues of the eye, the following classification is accepted:

• non-proliferative diabetic retinopathy;
• preproliferative diabetic retinopathy;
• proliferative diabetic retinopathy.

Development mechanism

The main source of energy for the body to function properly is glucose. Under the influence of insulin, a hormone of the pancreas, glucose enters the cells where it is processed. In diabetes mellitus, for some reason, insulin secretion is impaired. Unprocessed sugar accumulates in the blood, and as a result, metabolic processes in the body are disrupted. It leads to blockage and damage to the blood vessels of various organs, including the organs of vision. If you do not start correcting high glucose levels in time in patients with diabetes, diabetic retinopathy begins to develop over time.

Causes

The main cause of the pathology is an increase in sugar (glucose) in the blood for quite a long time.

Normally, blood sugar levels should not rise above 5.5 mmol/l on an empty stomach and 8.9 mmol/l after meals.

In addition, the occurrence of retinopathy is influenced by the presence of concomitant factors in patients with diabetes. They can not only provoke the formation of such a complication, but also accelerate its course.

• increased blood sugar levels;
• persistent hypertension (increased blood pressure);
• pregnancy;
• various types of pathologies and kidney diseases;
• overweight;
• smoking;
• alcohol;
• age-related changes in the cardiovascular system;
• genetically determined predisposition.

The course of the disease today is usually divided into four stages, each of which lasts quite a long time. There is an exception - with juvenile diabetes, vision loss can develop within a few months.

Stages of retinopathy in diabetes mellitus:

• I Art. non-proliferative– characterized by the appearance of minor local dilations of the retinal capillaries, as well as the appearance of hard exudative foci (lipid accumulations). Pinpoint hemorrhages appear in the central area of ​​the fundus. Such changes can also be observed in the deep layers of the retina, localized along the course of larger vessels and veins. The retina swells.
• II Art. preproliferative– changes become clear. The vessels become clogged, become more tortuous, double in size, their thickness is noticeably changed and may fluctuate. The number of hard exudative foci and hemorrhages increases, irreversible processes occur in nerve fibers that can lead to their necrosis, adding new “cotton-wool” exudates. A retina that is deficient nutrients and oxygen as a result of impaired blood flow, sends signals for the formation of new (abnormal) vessels.
• III Art. proliferative– fibrous tissue forms in places of hemorrhages, blood enters the vitreous body. Abnormal thin vessels with weak, fragile walls grow throughout the retina and vitreous body. Newly formed vessels often rupture, which leads to repeated hemorrhages, as a result of which the retina detaches. Localization of such neoplasms in the iris of the eye can lead to secondary glaucoma.
• IV Art. terminal– frequent and heavy hemorrhages into the vitreous body block vision. The increased number of blood clots stretches the retinal tissue and can lead to retinal detachment. Vision loss occurs when the lens stops focusing light on the macula.

Symptoms

The early stages of the disease are asymptomatic. Gradually occurring disorders:

• flickering of “flies” before the eyes,
• appearance of “stars” and slight fogging,

These are the first symptoms that do not cause inconvenience or discomfort to the patient. Such symptomatic manifestations are mistaken for fatigue and are not given attention.

Eye pain, decreased visual acuity, and loss of vision - late symptoms, appear as the pathology progresses at later stages, when the process has gone too far or has entered the stage of irreversibility.

Such symptoms indicate that anyone healthy person you just need to visit an ophthalmologist at least once a year, and for patients with diabetes mellitus every six months, for an examination of the organs of vision. This will allow symptoms of the disorder to be detected in the early stages of the disease, without waiting for obvious symptoms to occur when treatment medications may no longer be effective.

Diagnostics

When visiting an ophthalmologist, the doctor will examine the visual organs using all techniques to identify the most early signs diseases that occur without early symptoms.

Examination methods:

• visometry - checking visual acuity using a table;
• gonioscopy – determination of the viewing angle of each eye; if the cornea is damaged, it changes;
• ophthalmoscopy in direct as well as reverse form - checking the lens and vitreous body for transparency;
• Transmitted light examination – assessment of the condition of the choroid, optic nerve head, retina;
• ophthalmochromoscopy – helps to identify early changes in the fundus;
• biomicroscopy - examination of all eye structures with magnification up to 50–60 times using a slit lamp;
• tonometry – measurement of intraocular pressure.

Treatment

Since diabetic retinopathy develops against the background of metabolic disorders in the body caused by the presence of diabetes mellitus, the patient is prescribed complex treatment for diabetic retinopathy under the supervision of an ophthalmologist and endocrinologist. B Correctly selected diet and insulin therapy play an important role in the treatment of pathology.

Insulin therapy is aimed at compensating for carbohydrate metabolism disorders and is selected strictly individually. Correctly selected method of insulin therapy and its timely use significantly reduces the risk of occurrence and progression of the pathological process. Only an endocrinologist can choose the appropriate method, type of insulin and its dosage, based on the results of specially performed tests. To adjust insulin therapy, the patient will most likely need to be admitted to a hospital.

Therapeutic diet

People with this disease must adhere to proper nutrition, which is one of the main methods of complex therapy used.

Exclude from the diet:

• sugar, replacing it with substitutes (xylitol, sorbitol);
• baked goods and puff pastry products;
• bread of the highest and first grade;
• fatty meat, fish;
• sweet curd desserts and cheeses, cream;
• smoked meats;
• pasta, semolina, rice;
• fatty concentrated broths, soups cooked in milk with cereals, noodles;
• hot seasonings, sauces, spices;
• sweet carbonated and non-carbonated drinks, juices, including grape juice;
• honey, ice cream, jam

• gray, best rye, as well as bran bread;
• lean types of meat, poultry, fish - boiled and aspic;
• buckwheat, oatmeal, or pearl barley(by limiting bread);
• You should eat no more than two soft-boiled eggs or in an omelet per day;
• cheese, sour cream only in limited quantities;
• berries such as cranberries, black currant or compotes made from them, unsweetened apples, but not more than 200 grams per day;
• tomato and other unsweetened fruit and berry juices;
• coffee should be replaced with chicory.

The phytodiet is of particular importance. In patients with diabetes mellitus, acidification occurs in the body, which is why it is recommended to consume vegetables that have an alkalizing effect:

• zucchini;
• eggplant;
• cucumbers;
• pumpkin;
• Jerusalem artichoke.

Drink Birch juice half a glass to three times per day, fifteen minutes before meals.

Drug treatment

In drug treatment, the main place is occupied by:

• drugs that lower blood cholesterol levels;
• anabolic steroid;
• antioxidants;
• vitamins;
• angioprotectors;
• immunostimulants;
• biogenic stimulants;
• enzymes;
• desensitizing drugs;
• coenzymes and others.
• Hypocholesterolemic drugs:
• tribusponin;
• miscleron.

• Angioprotectors:
• angina;
• parmidine;
• doxium;
• dicinone" or "Etamsylate;
• trental;
• pentoxifylline.
• To treat the preproliferative stage of the pathology, the drug “Phosphaden” is used, which improves the hemodynamics of the eyes, general state fundus and stimulating metabolic processes
• The immunomodulating effect in the early stages of the disease is achieved by using the tablet drug “Levomezil”, and injectable drugs “Tactivin”, “Prodigiozan”.
• Vitamins of group B, C, E, R.
• Restoring and improving metabolism in the eye tissues: drugs “Taufon”, “Emoxipin”.
• Intraocular administration of enzyme preparations “Lidaza” and “Gemaza” is used in the presence of pronounced hemorrhages.

You can achieve high results in treatment using the Sidorenko Glasses physiotherapy device, which is easy to use at home and improves blood circulation.

Unfortunately, drug treatment can be effective only in the initial stages of this type of retinopathy. In later periods of its development, laser therapy is used.

Laser coagulation allows you to slow down or even stop the process of proliferation of newly formed vessels, strengthens their walls and reduces permeability to a minimum. The likelihood of retinal rejection is reduced.

At neglected form diabetic retinopathy requires surgical intervention– vitrectomy.

Elimination of risk factors: stabilization of body weight, treatment hypertension, giving up alcohol and smoking helps restore metabolic processes, increases the result of treatment.

Traditional methods of treatment

The initial stages of retinopathy can respond quite well to treatment medicinal herbs, you can use folk remedies and at later stages in combination with drug treatment.

If you drink an infusion instead of tea linden color, you can lower your glucose levels. Preparing the infusion is very simple: pour two tablespoons of linden blossom into 0.5 liters of boiling water. Leave for about half an hour.

The “Genius” collection improves blood flow in the retinal vessels and reduces the risk of retinopathy. Pour two tablespoons of the collection into half a liter of boiling water, leave for 3 hours, strain. Take 1/2 cup ten minutes before meals 3-4 times a day. The course of treatment is up to 4 months.

Blueberries restore visual acuity well. Every day, 3 times a day, regardless of meals, you should take one tablespoon of berries. At any time of the year, frozen blueberries are sold in stores. It is also recommended to take infusions from herbal teas that contain this dried berry.