Diabetic retinopathy is eye damage caused by diabetes. Diabetic retinopathy

Vascular problems at diabetes mellitus are one of frequent complications diseases. Slow progression of microangiopathic disorders ensures long absence serious problems. Most early manifestations pathologies become changes in vision: with diabetes mellitus it can cause blindness against the background of metabolic-endocrine pathology that lasts more than 15 years.

Timely detection of the disease and careful implementation of the doctor’s recommendations reduces the risk of complications, but one must understand that diabetic retinopathy is the most common cause vision loss in people aged 20-70 years.

Microangiopathy in diabetes

In patients with diabetes, damage to medium vessels (macroangiopathy) and small capillaries (microangiopathy) is possible. Considering the widespread prevalence of metabolic conditions and insulin metabolism disorders (up to 15% of the world's population), the risk of increasing dangerous vascular pathology extremely high. One of the first doctors to notice diabetic retinopathy is an ophthalmologist.

The fundus is an ideal place to identify primary capillary disorders. The retina is provided big amount small vessels, by changes in which the doctor will quickly and reliably see initial manifestations diseases. The pathogenesis of diabetes is characterized by the following factors:

• changes in the structure and thickening of the microvascular bed;
• proliferation of capillary endothelial cells;
• slowing blood flow in the retina;
• accumulation of protein substances inside capillaries;
• local expansion of microvessels;
• retinal ischemia;
• formation of new capillaries and veins.

Diabetic angioretinopathy progresses much faster with combined metabolic syndrome, when, in addition to diabetes, the patient suffers from arterial hypertension and obesity.

Pathology options

Complications of diabetes mellitus may occur different options eye diseases, of which most often the doctor will detect the following types of pathology:

• diabetic angioretinopathy;
• secondary neovascular glaucoma;
• diabetic cataract;
• recurrent erosions of corneal ulcers;
• secondary keratopathies.

The cause of complete loss of vision in diabetes mellitus in 70% is retinopathy, and other diseases lead to blindness in 30% of cases.

The classification of diabetic retinopathy determines the course of the disease, when pathological changes are formed in the microvessels of the retina over a long period of time, leading to a gradual deterioration in visual acuity. Highlight next stages diabetic retinopathy:

1. Non-proliferative diabetic retinopathy (simple) - vision is not impaired, but the doctor will pay attention to typical symptoms and vascular complications;
2. Preproliferative diabetic retinopathy, which is the cause of the patient’s first complaints, and during ophthalmoscopy the specialist will notice pronounced pathological changes in the fundus;
3. Proliferative diabetic retinopathy - hemorrhages and impaired blood flow in the capillaries becomes the main negative factor for the eyes;
4. Late complications – the stage of outcomes is characterized by conditions and diseases that are immediate cause blindness (retinal detachment, maculopathy, glaucoma with severe pain syndrome, vitreous hemorrhage).

An important condition for preventing extreme stages of microvascular pathology is timely and correct treatment diabetes mellitus: regular and precise dosing of insulin injections reduces the risk of microangiopathies, preventing early forms eye diseases.

Manifestations of the disease

The standard ophthalmoscopic symptom of diabetic retinopathy is microaneurysms of retinal capillaries. The first stages of pathological vascular changes are characterized by the following signs:

• microaneurysms in the center of the fundus (ischemic maculopathy);
• pinpoint hemorrhages;
• tortuosity and unevenness of venous microvessels;
• expansion of capillaries with detection of small ones;
• accumulation of exudate in ischemic areas.

For proliferative diabetic retinopathy, in addition to the typical changes of stages 1-2, the following symptoms are characteristic:

• the formation of new capillaries and veins in all parts of the retina;
• hardening of areas of exudation;
• fibrosis of hemorrhage foci with the formation of intraocular cords;
• repeated hemorrhages with deterioration of retinal nutrition.

Severe pathological changes in the fundus with rapidly progressive loss of vision occur on late stages. With type 2 diabetes, the risk of dangerous complications is much lower, but in the absence of effective treatment and blood glucose control, the likelihood of developing retinopathy is about 30%. Prognostically negative factors are availability hypertension and metabolic syndrome.

Diagnostic measures

Ophthalmoscopy

Most available method detection of simple or proliferative diabetic retinopathy - ophthalmoscopy. During a standard examination, the doctor will notice vascular disorders even when the patient does not know about the presence of diabetes. The specialist will perform the necessary tests, evaluating both eyes using the following procedures:

• determination of visual fields;
• assessment of intraocular pressure;
• examination of eye structures at a slit lamp;
• ultrasound and electrophysiological examination;
• special angiography of eye vessels.

Treatment of diabetic retinopathy should begin as early as possible to prevent dangerous complications. A prerequisite for therapy is joint management of the patient by an endocrinologist and an ophthalmologist.

The need for regular follow-up consultations with the ophthalmologist is determined by the doctor.

Therapy tactics

The basis of successful therapy is normalization of blood sugar levels. Without properly selected insulin therapy it is impossible to create optimal conditions for the treatment of diabetic retinopathy. The main methods of influencing blood vessels fundus are:

• improvement of metabolic processes in the eyes;
• restoration of blood flow in microvessels;
• resorption of foci of hemorrhage;
• removal of newly formed capillaries;
• surgical treatment of complicated diabetic retinopathy.

Drug therapy is effective in the first stages of the disease, when eye drops with vitamins and metabolic drugs you can improve blood supply to the retina. Provides good absorption effect enzyme preparations(Lidaza, Chymotrypsin).

The optimal method of treatment against the background of proliferation and vascular neoplasm is laser therapy. Coagulation of newly formed and dilated capillaries will help prevent mass unpleasant complications. Indications for surgery there will be the following situations:

• vitreous hemorrhage;
• detection of progressive diabetic cataracts;
• pronounced fibrin deposits;
• identification of intraocular strands with a high risk of tractional retinal detachment.

Surgery eliminates the risk of complete vision loss, but does not remove the underlying causative factor Therefore, monitoring of diabetes and treatment of retinopathy must be continued.

Risk of complications and prevention

The greatest danger to the eyes occurs in children with type 1 diabetes mellitus receiving insulin therapy. With age, the likelihood of the following complications gradually increases:

• hemophthalmos;
• glaucoma;
• cataract;
• retinal disinsertion;
• blindness.

Prevention of diabetic retinopathy includes constant monitoring of diabetic patients by an ophthalmologist, even in the absence of complaints and symptoms of visual impairment. The frequency of doctor visits is at least once a year. When diabetes is combined with arterial hypertension, obesity, and kidney disease, scheduled visits to the ophthalmologist should be carried out more often. It is impossible to completely rid the patient of it, but it is necessary to create maximum conditions for timely detection of complications and indications for surgical treatment.

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Diabetic retinopathy– one of the typical complications of diabetes mellitus. It is a lesion of the vascular structures of the retina in the form of a progressive pathology, leading in the terminal stages to complete loss of vision.

What are the reasons for this process? How is it detected and treated? What other complications are typical for diabetic retinopathy and is disease prevention effective? You will read about this and much more in our article.

Causes of diabetic retinopathy

The direct cause of the development of diabetic retinopathy is a complex pathological process during the development of diabetes mellitus. Complex mechanism pathogenesis is tied to a violation of microcirculation in the visual system against the background of metabolic changes - the hematoretinal barrier becomes permeable to large molecular structures of the bloodstream and unwanted substances enter the retina.

Consecutive negative processes include, as diabetic retinopathy develops, vasodilation, an increase in the intensity of blood flow in the visual system, damage to endothelial structures, capillary occlusion, a significant increase in the permeability of the blood vessels, the formation of aneurysms and physiological shunts, neovascularization, and hemorrhages. The final stage is retinal degeneration.

Additional provoking factors that “spur” the development of diabetic retinopathy are arterial hypertension, frequent hyperglycemia, concomitant metabolic syndromes, obesity, chronic renal failure, dyslipidemia, hereditary predisposition, age-related changes hormonal levels, pregnancy and bad habits, in particular alcoholism and regular smoking.

Classification and symptoms of diabetic retinopathy

The modern generally accepted classification of diabetic retinopathy includes 3 main forms of the disease with their own characteristics:

• Diabetic eye retinopathy stage 1(non-proliferative). Hemorrhages and small aneurysms in the form of spots or dots, predominantly dark in color, localized along the location of large veins and the central part of the fundus of the eye. Exudative foci of retinal edema in the macular area are also observed;
• Diabetic retinopathy stage 2(preproliferative). The patient has serious venous abnormalities in the visual system, which are accompanied by a large number of grouped exudates (hard or loose), retinal hemorrhages, intraretinal microvascular abnormalities;
• Diabetic retinopathy grade 3(proliferative). Neovascularization of parts of the retina, hemorrhages into the vitreous body, and the formation of fibrous structures in the localization of preretinal hemorrhages are diagnosed. The resulting vessels are very fragile and thin, usually leading to the rapid formation of glaucoma.

Symptoms that correlate with the above forms of the disease include:

• At 1st degree. Absence of visually expressed manifestations - they can only be detected when carrying out complex hardware diagnostics;
• At 2nd degree. Blurry of visible objects, problems with near vision when doing work or reading;
• At 3 degrees. Significant deterioration of vision, appearance dark spots and veils of dynamic localization that can disappear and reappear. When terminal stage– complete loss of vision.

Diagnosis of injury

A set of diagnostic measures carried out by a qualified ophthalmologist includes:

• Primary examination eyeball and centuries;
• Carrying out viziometry;
• Measuring intraocular pressure;
• Microbioscopy of the anterior part of the organ;
• Microbioscopy of the vitreous body and lens using a slit lamp;
• Ophthalmoscopy along all meridians, from the central part of the eye to the periphery, both direct and reverse;
• Retinal monitoring with slit lamp and Goldmann lens;
• Stereoscopic photography of the fundus using a non-mydriatic and fundus camera;
• Fluorescein angiography;
• Other activities as necessary, including laboratory tests.

Treatment for stage 1 diabetic retinopathy

The treatment procedure for stage 1 diabetic retinopathy includes mainly conservative techniques. Basic actions are not primarily aimed at correcting the condition of a patient with diagnosed diabetes mellitus.

Main activities include:

• The most careful control over the parameters of carbohydrate and fat metabolism. We are talking about measuring blood sugar levels and using insulin (for type 1 diabetes) or hypoglycemic agents (for type 2 diabetes) in a dosage clearly indicated by the endocrinologist;
• Correction of the diet with a decrease in carbohydrate foods in the diet according to a separate scheme prescribed by a specialized specialist;
• Taking angioprotectors, antiplatelet agents, antihypertensive drugs and other drugs for the maintenance therapy of diabetes mellitus, which reduces the likelihood of developing complications of the underlying endocrinological disease;
• Optimization of lipid metabolism control and blood pressure;
• Taking Cavinton, dicion, trental, antioxidants, enzymes and vitamin-mineral complexes to normalize the functioning of the vascular periphery, generally strengthen the immune system, and replenish deficiencies useful substances in organism;
• Injections of endothelial growth factor inhibitors of vascular structures. They are carried out directly into the eye cavity, the typical drug is ranibizumab;
• Intravitreal steroid injections to eliminate macular edema;
• Other activities on vital and objective indicators.

In case of ineffectiveness conservative therapy and further development of diabetic retinopathy, the ophthalmologist may recommend additional hardware treatment or surgical intervention.

Treatment for stages 2 and 3 diabetic retinopathy

Further progression of degenerative lesions of the retina in diabetic retinopathy requires additional measures to prevent the development of the disease. In addition to conservative therapy and following the recommendations of an ophthalmologist, endocrinologist, cardiologist, it is rational to use laser correction, as well as direct surgery.

Possible techniques:

• Photocoagulation. A popular non-invasive ophthalmological procedure, which is a targeted “cauterization” of the retina to prevent the growth of tumors in the form of blood vessels. As modern medical statistics show, laser coagulation can significantly slow down the development of diabetic retinopathy of degree 2 in 80 percent of cases and degree 3 in 50 percent of cases, while simultaneously stabilizing the patient’s condition. Under the influence of a directed beam, “extra” vessels are destroyed, after which the treated areas are overgrown with fibrous structures. The event is held under local anesthesia in an outpatient or hospital setting. The patient is in a sitting position, his chin and forehead are fixed. A special lens is placed on the eye and the gaze is focused directly. Laser treatment of problem areas is replaced by the application of coagulants, after the procedure, which lasts about half an hour, instillation of antiseptics is carried out;
• Vicrectomy. It is prescribed for low effectiveness of photocoagulation, the appearance of additional complications in the form of retinal detachment, fibrous changes in the vitreous body, and intense hemorrhages. The main operation is carried out under general anesthesia by cutting the retinal ligaments and removing the vitreous, which is replaced with a special solution. At the same time, a specialized specialist removes all clots that arose during previous hemorrhages. The success of the operation in the general case is about 80 percent, but if the retina has previously been detached and it has to be returned to its place, but the probability positive impact falls by 20-30 percent.

It should be understood that it is impossible to completely get rid of diabetic retinopathy - all the main therapeutic actions are aimed at slowing down degenerative processes, stabilizing the state of the visual system, maintaining the quality and acuity of vision.

Diet and nutrition

For diabetic retinopathy, endocrinologists, nutritionists, ophthalmologists and other specialized specialists recommend the maximum possible correction nutrition aimed at stabilizing carbohydrate and fat metabolism in the presence of obvious forms of diabetes. Basic principles of the diet:

• Refusal to eat foods containing large amounts of simple, easily digestible carbohydrates;
• Fractional meals in small portions, 5-6 times a day;
• Exclusion from the diet of smoked, fried, salty and spicy foods. It is recommended to cook by steaming, boiling, and sometimes baking. You should also significantly limit the use of offal, fast food, marinades, carbonated drinks, fatty meat and fish;
• Canned food, alcohol and sugar are completely prohibited - the latter is replaced by fructose-based products or artificial sweeteners.

Recommended for regular use on the menu low-fat varieties meat and fish, cereals, durum wheat pasta, whole grain bread with bran, greens, fresh fruits and berries (including apples, pears, blueberries, cranberries, oranges, kiwis, grapefruits, but excluding bananas, raisins, grapes, figs).

Dairy products - only low-fat, eggs can be used limitedly, no more than 1 piece per day. For drinks, it is recommended to consume juices, compotes and fruit drinks without sugar, rosehip decoction, tea, mineral water, coffee drinks cafein free.

Under any circumstances, correction of the diet must be agreed with the attending physician., especially the introduction of new, previously unused products into the diet.

During the treatment of retinopathy in diabetes mellitus, nutrition is very important!

Prognosis and possible complications

Diabetic retinopathy itself is a complication of diabetes, and it cannot be completely cured. On early stages development of pathology with timely diagnosis, carrying out complex measures of conservative, hardware and surgical therapy, the development of pathology can be significantly slowed down and even stopped.

In advanced cases, especially when diabetes is combined with atherosclerosis, hypertension and other problems, the chances of preserving vision are quite low even with surgical intervention.

TO typical complications Diabetic retinopathy usually includes:

• . It is provoked by the abnormal growth of new vessels and the proliferation of scar tissue;
• . Almost always on medium and late stages development of diabetic retinopathy, secondary glaucoma is formed. An increase in intraocular pressure, in turn, in the presence of the pathologies described above, can damage the optic nerve and other elements of the eye;
• Hemorrhages into the vitreous body. A typical problem of stages 2 and 3 of diabetic retinopathy, in some cases requiring vicrectomy.

Prevention of diabetic retinopathy

As modern medical practice, the only, most reliable method of preventing the development of diabetic retinopathy is a comprehensive, controlled compensation of the manifestations of diabetes mellitus.

If a person is at risk, then he needs regular monitoring of his condition both by an ophthalmologist (examination 2-4 times a year) and an endocrinologist, as well as other specialists, in particular a cardiologist, nephrologist.

In addition to specific preventive measures We should not forget about normalizing circadian rhythms, regular physical activity, and minimizing the risks of developing stressful situations, other general strengthening measures that improve the patient’s quality of life.

Now you know everything about the causes, symptoms and treatment of diabetic retinopathy, as well as treatment methods: drugs, diet and folk remedies.

Risk factors for developing diabetic retinopathy

One of the most common complications of proliferative diabetic retinopathy is progressive vision loss. Diabetic retinopathy is more common in type 1 (40%) than in type 2 diabetes (20%) and is the most common cause of legal blindness between the ages of 20 and 65.

The duration of diabetes is the most significant risk factor. Diabetic retinopathy rarely develops in the first 5 years of the disease or before puberty, but 5% of patients with type 2 have diabetic retinopathy when the disease is diagnosed.
Poor metabolic control is as significant a risk factor as disease duration. It is known that good blood glucose control can prevent or delay the development of diabetic retinopathy.
Nephropathy causes worsening of diabetic retnopathy. Other risk factors include overweight, hyperlipidemia and anemia.

Forms of diabetic retinopathy

The following forms of diabetic retinopathy are distinguished::
non-proliferative (background) diabetic retinopathy- the first stage of diabetic retinopathy, which is characterized by occlusion and increased permeability of small vessels of the retina (microvascular angiopathy); background retinopathy is characterized by a long-term course with complete absence any visual impairment
preproliferative diabetic retinopathy- severe nonproliferative retinopathy, which precedes the appearance of proliferative retinopathy
proliferative diabetic retinopathy- develops against the background of non-proliferative diabetic retinopathy, when capillary occlusion leads to the emergence of large areas of impaired blood supply (non-perfusion) of the retina; the “starving” retina secretes special vasoproliferative substances designed to trigger the growth of newly formed vessels (neovascularization)
diabetic macular edema- damage to 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 proliferative form diabetic retinopathy, but can also be observed with minimal manifestations of non-proliferative diabetic retinopathy; V initial stages development of macular edema, visual impairment may also be absent

In 1984 prof. L.A. Katsnelson developed a classification of diabetic retinopathy, which allows us to distinguish 2 main forms of the disease:

Preproliferative form:
vascular phase
exudative phase (with macular edema, without macular edema)
hemorrhagic or exudative-hemorrhagic phase
Proliferative form:
with neovascularization
with gliosis stages I, II, III, IV
with traction retinal detachment

It is understood that each subsequent phase contains elements of the previous one.

Pathogenesis

The key factor in the development of diabetic retinopathy is insulin deficiency, which causes the accumulation of intercellular sorbitol and fructose, which contributes to an increase in osmotic pressure, the development of intracellular edema, thickening of the capillary endothelium and narrowing of their lumen, and microthrombosis occurs. Impaired perfusion in the parafoveal vessels creates conditions for the development of exudative maculopathy. Progressive obliteration of retinal capillaries causes retinal ischemia, accompanied by the production of a vasoformative factor that promotes the development of neovascularization as the beginning of proliferative changes in the fundus.

The main links in the pathogenesis of diabetic retinopathy are:
microangiopathy of retinal vessels, leading to narrowing of the lumen of blood vessels with the development of hypoperfusion
vascular degeneration with the formation of microaneurysms
progressive hypoxia, stimulating vascular proliferation and leading to fatty degeneration and deposition of calcium salts in the retina
microinfarctions with exudation, leading to the formation of soft “cotton-wool spots”
lipid deposition with the formation of dense exudates; proliferation of proliferating vessels in the retina with the formation of shunts and aneurysms, leading to dilatation of the veins and aggravation of retinal hypoperfusion
the phenomenon of stealing with further progression of ischemia, which causes the formation of infiltrates and scars
retinal detachment as a result of its ischemic disintegration and the formation of vitreoretinal tractions
vitreous hemorrhages resulting from hemorrhagic infarctions, massive vascular invasion and ruptured aneurysms
proliferation of iris vessels (diabetic rubeosis), leading to the development of secondary glaucoma
maculopathy with retinal edema

The causes of decreased vision in diabetes can be divided into 2 groups::
Damage to the light-receiving part of the eye, i.e. retina (diabetic retinopathy, in severe cases complicated by retinal detachment) and optic nerve(diabetic neuropathy).
Damage to the light-conducting part of the eye. Normally, the optical environment of the eye, i.e. The lens and vitreous body, which conduct and refract light rays, focusing them on the retina, are transparent. In diabetes, clouding of the lens (cataract), hemorrhage into the vitreous body (hemophthalmos), and clouding of the vitreous body with cicatricial changes may develop.

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.

Diagnostics

The main diagnostic methods are ophthalmoscopy and FAHD (fluorescein angiography of the fundus). Ophthalmoscopy for diabetic retinopathy reveals a variety of pathological changes in the fundus.

Differential diagnosis

Retinopathy due to retinal vein thrombosis and hypertensive retinopathy.

Treatment of diabetic retinopathy

Basic principles of treatment of diabetic retinopathy. Treatment of diabetic retinopathy is considered as an integral part of the treatment of the patient as a whole and is based on the following principles:
detection of retinal damage (screening) and subsequent dynamic monitoring of its condition (monitoring)
optimal compensation of carbohydrate and lipid metabolism, blood pressure control, normalization of kidney function, etc.
treatment of retinal damage

It is important systemic management of the underlying disease- careful monitoring of blood glucose levels, blood pressure, and kidney function.

Laser treatment It 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 the destruction of zones of retinal hypoxia, which is the source of the release of growth factors of newly formed vessels; increasing the direct supply of oxygen to the retina from choroid; thermal coagulation of newly formed vessels.

For preproliferative or proliferative diabetic retinopathy laser burns are applied to the entire retina, excluding it central departments(panretinal laser coagulation). Newly formed vessels undergo focal laser irradiation. This surgical method is particularly effective in early start treatment, 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 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.

Surgery(vitrectomy) indicated for massive intraocular hemorrhages or advanced proliferative retinopathy. With hemophthalmia, the patient is recommended to spend maximum time sitting with both eyes closed - this simple method contributes to 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 diabetic retinopathy, if this does not happen within 1 month, then vitrectomy is performed.

Vitrectomy consists in removing blood clots, clouded portions of the vitreous body and fibrovascular cords 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 an important role in the development of proliferative retinopathy, is removed.

Drug therapy. The drugs of choice are angioprotectors, for example doxium (calcium dobesilate). Also used: antioxidants, antiplatelet agents, agents that improve microcirculation.

Inspection frequency:
first examination: the patient should be examined by an ophthalmologist no more than 5 years after the diagnosis of diabetes; in domestic conditions, given the insufficient level of compensation for the disease, it is advisable to carry out the first examination no later than 1.5-2 years from the date of diagnosis of diabetes in the absence of diabetic retinopathy: at least once every 1-2 years
if there are signs of diabetic retinopathy: examination should be carried out at least once a year, and more often if necessary, for example, if there are signs of rapid progression of diabetic retinopathy, with intercurrent diseases
when diabetic retinopathy is combined with pregnancy, arterial hypertension, chronic renal failure, risk groups are being formed that need individual control for the development of this complication
the likelihood of developing severe retinopathy in prepubertal age is low, so ophthalmological examination of children under the age of 10 years is usually not carried out; it should be timed to coincide with the onset of puberty; At this time and thereafter, examinations should be carried out at least at 2-year intervals, if diabetic retinopathy is detected - at least once a year, and in the case of intercurrent disease or deterioration of kidney function - even more often
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

Course and prognosis of diabetic retinopathy good with adequate and timely treatment. If treatment is not started in a timely manner, the outcome of the process may result in blindness. The severity of diabetic retinopathy increases significantly if blood glucose levels are equal to or greater than 200 mg%.

Screening for diabetic retinopathy

The screening task includes: identification of patients with increased degree risk for the development of diabetic retinopathy (for example, when retinopathy is combined with pregnancy, arterial hypertension, chronic renal failure), which require careful monitoring.

The following stages of screening are distinguished::
collection and analysis of anamnesis, clinical and laboratory examination
verification of the initial stages of manifestation of visual impairments
determination of visual acuity with correction
exclusion of glaucoma
mandatory pupil dilation
lens examination
fundus examination

Recommendations for primary and secondary prevention of diabetic retinopathy:
Glycemic control (any decrease in the level of glycated hemoglobin leads to a decrease in the likelihood of developing diabetic retinopathy). The target level for patients with is an HbA1c level below 7%. (If you have retinopathy rapid decline level of glycated hemoglobin can lead to a worsening of diabetic retinopathy, therefore sharp decline blood glucose is recommended to be avoided).
A decrease in systolic and/or diastolic blood pressure leads to a decrease in the likelihood of developing diabetic retinopathy. The target blood pressure level for patients with diabetic retinopathy is below 130/80 mmHg. rt. Art.
Reducing the level of low-density lipoprotein (one of the cholesterol fractions) leads to a reduced risk of microvascular complications. It has been suggested that lipid-lowering therapy may benefit patients with macular edema.
Early laser photocoagulation of the retina is recommended for patients with proliferative diabetic retinopathy.
For patients with less pronounced changes on the fundus without indications high risk loss of vision, close observation may be chosen. However, treatment (LC - laser coagulation) is more preferable, especially in patients with type 2 diabetes mellitus, as well as in the event of unfavorable signs or the impossibility of frequent qualified supervision.
For patients with macular edema and decreased visual acuity, focal laser photocoagulation is recommended, but patients should be warned about possible risks therapy.
For patients with type 1 diabetes mellitus and severe vitreous hemorrhage and significant diabetic retinopathy, early surgical vitrectomy (within 3 months after hemorrhage) is recommended. Removal of the vitreous is also considered possible treatment with severe proliferative retinopathy that does not improve after panretinal LC, as in in some cases macular edema.
Although intravitreal triamcinolone may be beneficial in severe cases of diffuse macular edema refractory to focal LC, patients should be warned about the common side effects of this treatment (increased intraocular pressure, cataracts, and sometimes the need for re-treatment).
The use of aspirin does not reduce the risk of developing diabetic retinopathy and does not increase the risk of hemorrhages in the fundus and/or vitreous.

Many common diseases are very insidious, and in certain cases can become seriously complicated, bringing a lot of inconvenience to the patient. This pathological condition how diabetes mellitus often leads to complex disorders, including skin lesions, and vascular diseases, and difficulties in kidney function. So a fairly common complication of diabetes is diabetic retinopathy, the symptoms and treatment of which, as well as drugs for correcting the disease, we will now look at on this page www.site.

The term “diabetic retinopathy” refers to retinal damage that sometimes develops with diabetes. This pathological condition requires especially careful attention and can cause blindness. Diabetic eye retinopathy progresses rather slowly and is provoked high level blood glucose levels.

Symptoms of diabetic retinopathy

The main insidiousness of diabetic retinopathy is that this disease is practically asymptomatic for a long time. Sometimes the disease practically does not make itself felt even at an advanced stage. In this case, the patient does not feel any disturbances in the quality of vision and, of course, does not consider it necessary to seek doctor’s help. However, it is worth considering that effective treatment diabetic retinopathy, which allows you to preserve vision, is possible only in the initial stages of the disease. Therefore, if you have diabetes, you need to regularly visit an ophthalmologist-retinologist. Such visits should be made at least once every six months, or even more often.

In some cases, diabetic retinopathy still makes itself felt. This pathological condition can manifest itself as unclear or distorted vision of objects, and patients encounter difficulties in reading. Also, this disease sometimes causes flies to flash before the eyes. Diabetic retinopathy of the eye can provoke partial or complete loss of vision, shadows or blurred vision. Patients also often experience eye pain.

About how diabetic retinopathy is corrected, what treatment helps

Treatment for diabetic retinopathy largely depends on the stage of the disease. If a patient is diagnosed with such a disorder, the doctor can select drug treatment for him, recommend laser coagulation, or surgical intervention.

It is simply impossible to completely cope with diabetic retionopathy, but timely laser therapy helps prevent vision loss. The quality of vision can also be improved by removing the vitreous body - vitrectomy. However, the progression of the disease requires repeated interventions.

Sometimes you can slow down the course of the disease by giving injections into the eye cavity. In this case, the patient is administered anti-VEGF drugs - inhibitors of vascular endothelial growth factor. These medications include Ranibizumab. Injections can be carried out in parallel with laser coagulation, and sometimes they are carried out on their own.

Medicines to treat diabetic retinopathy

When treating diabetic retinopathy, the most various medications, which help improve the condition of the retinal vessels, slow the progression of the disease and reduce its manifestations.

The drug of choice for diabetic retinopathy is often Neurovitan, which contains a number of B vitamins in a therapeutic dosage. Studies have shown that this medication is safe and quite effective, in addition, it is not capable of causing side effects. Vitrum is also often used among vitamin compositions. Vision Forte.

The doctor may also recommend taking medications based on Ginkgo Biloba. Such drugs are available in capsule form; they are usually taken like vitamins - one or two capsules per day. Positive effect With this treatment, it is observed after about one month of daily use.

Diabetic retinopathy can also be treated with the use of Retinalamin. This medicine is a tissue repair stimulator; it is based on a complex of water-soluble polypeptide fractions of the retina of livestock eyes. Retinalamin is able to optimize the permeability of the vascular endothelium, reduce the intensity of local inflammatory processes. This medicine administered parabulbarly - through the skin of the lower eyelid. Five to ten milligrams of the active substance are administered per day, diluting it with 1-2 ml of saline solution or water for injection.

Sometimes doctors also advise using Vasomag, it active substance– meldonium dihydrate. This medicine is able to optimize metabolism, as well as energy supply to tissues. Its timely use in diabetic retinopathy helps stop or slow down pathological processes. Vasomag is also administered parabulbarly.

Treatment of diabetic retinopathy can also be carried out using medications that directly affect the capillaries of the retina. These primarily include Troxevasin and Venoruton, they are used in the form of capsules.

Eye drops for diabetic retinopathy also help. For example, you can pay attention to the drug Emoxipin. The drug is available in ampoules. The contents of the ampoule are drawn up with a syringe, then the needle is removed and the liquid is instilled into the eye. It is also administered by injection. This is only done in a hospital setting. Instill 1 to 2 drops as directed by the doctor 3 to 5 times a day for 30 to 60 days in a row. As you understand, with such a range of values, using the product on your own is contraindicated. Only a doctor can give orders for its use. Not everything is shown here important information regarding the drug Emoxipin, and therefore carefully study its instructions for use.

Successful treatment of diabetic retinopathy largely depends on its timely diagnosis.

Diseases of the organs of vision are one of the most current problems. Every year thousands of people lose their ability to work due to the onset of partial or complete blindness. The situation is aggravated by the fact that many dangerous pathologies can be asymptomatic for a long time and are detected only in the later stages of their development. Diabetic retinopathy is one of these diseases. How to recognize in time this state and prevent negative consequences?

Diabetic retinopathy as a complication of diabetes mellitus

Diabetic retinopathy is a dangerous complication of diabetes mellitus, a pathology in which the production of insulin by the pancreas is impaired.

Insulin is a substance involved in the regulation of metabolism by distributing sugar and controlling its level in the body. With its deficiency, the absorption of sugar by cells is disrupted, as a result of which all organs feel an acute shortage of the latter. This, in turn, leads to failures and triggers numerous pathological processes.

Diabetic retinopathy causes damage to the retina of the eye, which is fraught with microaneurysms and hemorrhages.

With diabetic retinopathy, damage to the vessels of the retina occurs, which is fraught with loss of vision and, as a consequence, disability.

The disease is equally characteristic of both women and men. Age doesn't matter either. Patients with diabetes mellitus with more than 10 years of experience (both insulin-dependent and non-insulin-dependent) are at risk.

Structure of the eye - video

Mechanism of development, risk factors and classification of pathology: non-proliferative, pre-proliferative, proliferative

Insulin deficiency, which occurs in diabetes, leads to the fact that sugar entering the body is not absorbed by cells and tissues and, as a result, remains uninvolved in metabolism and, gradually accumulating, provokes the appearance of hyperglycemia. Hyperglycemia, in turn, negatively affects vascular permeability, causing diabetic retinopathy.

Retinal vascular permeability, characteristic of diabetic retinopathy, leads to the appearance of blood clots in the vitreous

There are several forms of diabetic retinopathy:

1. Non-proliferative (background) – represents easy stage, in which there is increased vascular permeability, their expansion, as a result of which small hemorrhages into the vitreous body, mild edema occur, and there is also a partial disruption of the blood supply to the retina. Non-proliferative, in turn, is divided into the following forms:
   • vascular (vascular);
   • exudative (edematous);
   • hemorrhagic (accompanied by hemorrhages);
   • ischemic (characterized by vascular spasms).
     

     In case of early diagnosis and qualified treatment manages to take control further development diabetic retinopathy.

2. Preproliferative - in fact, differs from non-proliferative only in the degree of manifestation clinical signs, which are more pronounced at this stage. Significant deterioration of blood flow leads to the formation of areas of retinal infarction (“cotton wool lesions”), which create blind spots. It also has vascular, exudative, hemorrhagic and ischemic forms.
3. Proliferative is the most severe stage of the disease. It is characterized by the formation of new vessels (neovascular form), the rupture of which causes extensive hemorrhage into the vitreous body with subsequent formation fibrous tissue(gliotic diabetic retinopathy).

Diabetic retinopathy has three stages of development: non-proliferative, pre-proliferative, proliferative

Factors predisposing to the development of diabetic retinopathy are:

• puberty (from 12 to 17 years);
• pregnancy;
• obesity;
• smoking.

Due to the fact that pregnant women are at risk, during the period of bearing a child it is necessary to regularly visit an ophthalmologist and monitor your diet. Since in the event of the development of pathology, there is a huge probability that during the process of delivery, due to an increase in pressure, including eye pressure, extensive hemorrhage will occur in the vitreous body, and the woman may instantly go blind.

According to statistics, 3% of the world's population suffers from diabetes. In Russia this pathology diagnosed in more than 10 million people.

Symptoms and signs

The insidiousness of diabetic retinopathy lies in its asymptomatic course. The patient may not notice any symptoms until the disease reaches severe stages.

1. With hemorrhages into the vitreous body, patients, as a rule, complain of the appearance of spots in front of the eyes, which disappear on their own after some time.
2. As a result of swelling of the central part of the retina (macula), a “veil” is formed, causing a decrease in visual acuity and, as a result, discomfort when reading and working at close distances from objects.
3. With extensive tissue damage and retinal detachment, complete blindness may occur.

Diagnostics

Due to the fact that this pathology can occur secretly, diabetic patients should undergo regular ophthalmological examinations, even in the absence of visual complaints. Specialist in mandatory will carry out a survey and collect anamnestic data (analysis of the medical history), and also carry out the following diagnostic measures:

Differential diagnosis is carried out with glaucoma and retinal detachment. In this case, the ophthalmologist will also rely on data from gonioscopy (examination of the anterior chamber of the eye using a gonioscope) and ultrasound examination.

Treatment methods and acceptability of using folk remedies

The fight against diabetic retinopathy is usually aimed at preventing the development of complications, in particular blindness. For this disease, complex therapy is carried out, which includes: conservative treatment, and surgical intervention.

Note! Folk remedies not used for diabetic retinopathy. Improvement of the condition can only be achieved with the help of medications or surgery.

Conservative therapy: medications, eye drops, nutritional correction, etc.

Conservative therapy consists of:

• monitoring glucose levels, blood pressure (BP) and kidney function;
• taking medications;
• following a diet.

In most cases, patients are prescribed the following drugs:

1. Antioxidants and vascular strengtheners (Strix) - to reduce the permeability of retinal vessels.
2. Enzyme agents - to accelerate the resorption of hemorrhages.
3. Inhibitors of vascular endothelial growth factor (Avastin, Lucentis - injections) - to reduce the growth of newly formed vessels.

Previously, angioprotectors were actively used in the treatment of diabetic retinopathy, however latest research showed that drugs of this group are ineffective in this disease, especially in the case of the proliferative stage.

An important place in the treatment of diabetic retinopathy is given to the patient's adherence to a certain diet. A patient with diabetes should avoid consuming:

• sweets (cakes, pastries, sweets, ice cream, etc.);
• fatty and salty foods, kidneys, egg yolks;
• carbonated drinks;
• semi-finished products;
• pastry products;
• smoked meats;
• white rice;
• canned and pickled foods;
• packaged juices from the store;
• alcohol;
• grapes, bananas.

In addition, you should limit your intake of salt and potatoes.

Important! Those who dialed in Lately The popularity of sugar substitutes should also not be included in your diet. There is no benefit from them, but harm is a frequent topic of discussion in the medical community.

Foods that should be excluded from the diet - gallery

Grape Bakery Carbonated drinks Fatty dishes Canned foods Sweets

The permitted products include:

• fruits and vegetables in fresh(heat treatment is allowed) - cabbage, zucchini, pumpkin, spinach, cucumbers, tomatoes, radishes, beets and others;
• tea and weak coffee;
• fruit drinks and rosehip decoction;
• buckwheat and barley porridge;
• rye and whole grain bread;
• vegetable soups;
• lean types of fish and meat (chicken, rabbit, turkey, pollock, cod and others);
• dairy products, etc.

Products approved for consumption - gallery

Weak coffee Dairy products, including low-fat cheese, milk, sourdough Buckwheat with vegetables Fruit juice and rosehip decoction Boiled chicken breast Fresh or cooked vegetables Fruits other than grapes and bananas

Surgical intervention: cryo- and laser coagulation of the retina, vitrectomy

Surgical treatment is the most effective method therapy for diabetic retinopathy. There are several surgical options:

1. Laser coagulation (laser coagulation) – involves cauterizing bleeding vessels. It is performed under local anesthesia. Does not require long-term rehabilitation and is absolutely painless. Used for minor injuries, as well as for the prevention of retinal detachment.
2. Cryocoagulation is often used when laser coagulation and vitrectomy are contraindicated for some reason. During the operation they use low temperatures, the effect of which is similar to laser cauterization.
3. Vitrectomy is performed in case of extensive hemorrhage, as well as in the proliferative stage of the disease. It involves removing blood clots (hemophthalmos) and fibrovascular strands on the surface of the retina from the eye cavity. In most cases, the vitreous body itself is removed and replaced with a saline solution. All manipulations are performed under local or general anesthesia. Duration - 1–3 hours.

Treatment prognosis and possible complications

The prognosis of treatment directly depends on the severity of the disease. However, in most cases, when timely application Seeing a specialist can help you avoid a negative scenario and preserve your vision. Whereas in the absence of therapy and late diagnosis Diabetic retinopathy may cause the following complications:

• retinal disinsertion;
• partial or complete blindness;
• cataract;

One of possible complications diabetic retinopathy is a secondary glaucoma

Prevention

Preventing the development of diabetic retinopathy involves monitoring blood sugar levels, taking medications in a timely manner and regular ophthalmological examinations. In addition, the following help reduce the risk of developing the disease:

1. Proper and balanced nutrition.
2. Moderate physical activity.

Diabetic retinopathy is a common and quite dangerous complication of diabetes mellitus that can lead to complete loss of visual function. Therefore, patients who know about increased risk If they develop this pathology, it is imperative to visit an ophthalmologist, even if there are no symptoms of the disease.