What are diabetic maculopathy and retinopathy?
Diabetic maculopathy is one of two forms of diabetes that can affect the retina; the patient may have one or both. The first form is retinopathy, and the second is maculopathy. The retina can be divided into two distinct regions: the central retina called the macula and the peripheral retina. The macula is responsible for the vision of the reading, and the detail of color recognition, while the peripheral retina is responsible for the visual field.
Diabetes affects the blood vessels of the eye, particularly the vessels of the retina, which is the layer of the eye that we use to see. When an injury occurs in these vessels, it causes small hemorrhages and fluid loss, called edema. When the lesion occurs in the peripheral region of the retina, this early stage of retinopathy is called nonproliferative, and the patient can even see very well, even without the help of glasses. If the lesion occurs in the central region, the macula, vision, and reading details change, which is called diabetic maculopathy.
With the progression of the disease, bleeding can be seen in the eye (called vitreous hemorrhage), retinal detachment occurs, and at this time is called proliferative retinopathy.
At this stage, vision is significantly compromised and is not often irreversible blindness. Other complications can occur with the appearance of abnormal vessels in the iris (the colored part of the eye), leading to glaucoma (increased ocular pressure).
How to treat diabetic retinopathy and maculopathy?
In diabetic maculopathy, the treatment will depend on the type of deterioration and the stage in which the disease is found in the eye. It is essential to keep in mind that the control of diabetes is crucial for the success of eye treatment at any stage of retinopathy. Often, this control is not effective enough to slow the progression of the disease and its severe effects. After the diagnosis, it is common to need to perform background exams on the eye; It is known that the use of fluorescein angiography helps in the treatment. These tests consist of photographs taken of the eye, with and without contrast.
Depending on the stage of diabetic retinopathy, the treatment may be:
- Photocoagulation (use of laser).
Chronic open-angle glaucoma; In the early stages of diabetic retinopathy, the doctor can only observe and perform periodic retina examinations. Controlling the blood sugar rate is critical.
Photocoagulation (use of laser)
The laser application is very safe and effective. To achieve an adequate treatment, several laser applications are necessary. The primary purpose of the laser is to prevent the progression of the nonproliferative form to the proliferative state of retinopathy. In the case of maculopathy, laser, depending on the degree of involvement of the macula, can improve vision.
Laser treatment – Laser Retinopathy – Treatment of Maculopathy
The surgery is done to eliminate the vitreous hemorrhage, cauterize the vessels that led to the bleeding, and perform the photocoagulation surgery itself. If a retinal detachment occurs, the surgery aims to reposition it.
The most important thing is that all diabetic patients are examined by an ophthalmologist, even when the vision is good. Seeing directly does not mean that the retina is in perfect condition. The doctor can find and notice changes in advanced retinopathy without the patient’s knowledge. This is the best time of treatment, when indicated, to preserve vision. Prevention is critical in diabetes.
Retinal detachment, floaters, and flashes
What will be the floats?
Occasionally, you may see some dark spots walking from side to side in your field of vision. When looking at a transparent screen, for example, a white wall, these points may be more visible; it seems like they are floating in front of your eyes. They are inside. These points are small opacities in the transparent vitreous gel we all possess in this regard.
These dark spots may have other shapes, such as hair, spider, etc. These symptoms are common in the population, especially in myopic patients undergoing cataracts, eyes that had inflammation, or intraocular trauma.
Should I be in the constant ophthalmologic review if I have floaters?
The patient with floaters should be examined (fundus) in the following situations:
- If you notice floating spots that have never been discussed before.
- If he never noticed and noticed the appearance of floats suddenly.
- If you see floating spots, it has been discussed before, but you have noticed the formation of new places.
- If you have been operated on the eye (surgery), even for so long, and see the beginning of floats.
- If you received a blow to the eye and began to notice the floats.
- If you notice, in addition to the presence of flies flying, flashes of light or a shadow in sight.
What are the flashes of light?
When the vitreous gel separates from the retina, stimulation of the retina is interpreted by the brain as flashes of light; these can often occur. This symptom is significant to be noticed, especially if it starts suddenly. In such cases, the patient should be examined by an ophthalmologist as soon as possible.
Only the trained physician can distinguish between a detachment of the vitreous or a hole formed in the retina, which leads to the separation of the same.
What is the treatment for the flashes?
The patient with a flashlight should always be examined with a dilated pupil by analyzing the retinal cartography. If there is a retinal tear, but it is still stuck, the treatment will be done with the laser application. If there is a failure, the patient should be observed and examined again after some time.
What is retinal detachment?
The retina is the inner layer of the eye responsible for vision. When the separation occurs, the picture decreases to not seeing anything.
How is a retinal detachment produced?
The vitreous gel is in contact with the retina, increasing age spasms and separation of the retina. In some patients, when this occurs, the formation of a hole in the retina occurs. The liquid part of this gel goes behind the retina through this hole, causing the detachment to occur. This is the most common form of retinal detachment that arises.
Many patients perceive floaters and flashes of light at the beginning of the process. Still, many patients may manifest retinal detachment without having any of those symptoms before.
What is the treatment for retinal detachment?
In the vast majority of cases, the treatment is surgery. The surgery performed will depend on the type, size, and location of the detachment, but in general, there are five modalities of the surgery.
1-Intraocular gas injection.
3-Posterior vitrectomy with laser.
4-Posterior vitrectomy associated with intraocular injection of silicone oil.
5-The combination of the surgery above.