How is diabetic retinopathy treated

• Photocoagulation with LASER (Light Amplification by Stimulated Emission of Radiation) beams. Depending on the element used there are various kinds of laser beams, which emit at different wave length: Argon, Krypton, Xenon, Diode. Photocoagulation aims at producing a tissue chemical burn at a predetermined retinal area, with the least possible damage to the neural retina. The ultimate aim of photocoagulation is therefore to convert hypoxic retinal areas to anoxic, so that the mechanism of neovascularization is inhibited. Photocoagulation is absolutely indicated in the following situations: i) in severe and very severe NPDR; ii) in diabetic maculopathy; iii) in proliferative DR. In diabetic maculopathy, focal or direct and the grid-pattern photocoagulation is applied. In proliferative DR, panretinal photocoagulation is applied with 3-4 laser sessions. The benefit of decrease in the risk of visual acuity loss with laser treatments is more than 50 percent.

A high risk of blindness exists in diffuse or oedematous maculopathy, ischaemic maculopathy, vitreal haemorrhage and retinal detachment, due to contraction, as well as in haemorrhagic glaucoma.

Complications of laser photocoagulation include pain, transient loss or decrease in vision immediately after a laser session (it returns after a few hours), decrease of the visual optic field and haemorrhage in the fundus.

• Surgical treatment is implemented in cases of secondary retinal detachment from contraction, which is a serious complication of proliferative DR, and especially when the area of the macula is threatened. Repeated haemorrhages of the vitreous cavity are also an indication for surgical treatment, i.e. vitrectomy, with satisfactory effects in 40 percent of cases. During this operation, the cataract lens and the haemorrhagic vitreous body are removed, retinal integrity is restored and the retina is transferred back to its original position, so that evolution of the disease is inhibited.

• Medicines: aspirin administration has been tried in various studies, without success, however, as regards to inhibition of DR progress. ACE inhibitors have also been used in proliferative DR. Furthermore, good control of diabetes, hypertension, nephropathy, heart failure and anaemia are indispensable for a good outcome of DR. Encouraging results have also been reported with the use of somatostatin products.

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