Maculopathy and Diabetic Retinopathy: Treatment

What is diabetic maculopathy and retinopathy?

The  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 loss of fluid, 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 and the condition 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 very compromised and is not often an irreversible blindness. Other complications can occur with the appearance of abnormal vessels in the iris (the colored part of the eye) and with this lead 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 very important 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 in 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).
  • Surgery.

Chronic open-angle glaucoma; In the early stages of diabetic retinopathy, the doctor can only observe and perform periodic examinations of the retina. Controlling the blood sugar rate is key.

Photocoagulation (use of laser)

The laser application is very safe and effective. To achieve an adequate treatment several laser applications are necessary. The main purpose of the laser is to prevent the progression of the nonproliferative form to the proliferative form 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

Surgery

The surgery is done to eliminate the vitreous hemorrhage , cauterize the vessels that led to the hemorrhage and perform the photocoagulation surgery on itself. In the event that 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. The fact of 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 key 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 you are looking at a clear screen, for example, a white wall, these points may be more visible, it seems like they are floating in front of your eyes, actually they are inside. These points are small opacities in the transparent vitreous gel that we all possess in the eye.

These dark spots may have other shapes, such as hair, spider, etc. These symptoms are common in the population, especially in myopic patients undergoing cataract, eyes that had inflammation or intraocular trauma.

Should I be in constant ophthalmologic review if I have floaters?

The patient with floaters should be examined (fundus) in the following situations:

  • If you notice floating spots and has never been examined before.
  • If he never noticed and noticed the appearance of floats suddenly.
  • If you see floating spots, it has been examined before, but you have noticed the appearance of new spots.
  • 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, a stimulation of the retina is interpreted by the brain as flashes of light, these can often occur. This symptom is very important 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 flash light should always be examined with dilated pupil, through the examination of 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 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 vision decreases to the point of not seeing anything.

How is a retinal detachment produced?

The vitreous gel is in contact with the retina, with increasing age spasms and separation of the retina. In some patients when this occurs, the formation of a hole in the retina occurs. Through this hole, the liquid part of this gel goes behind the retina, causing the detachment to occur. This is the most common form of retinal detachment that occurs.

Many patients perceive floaters and / or flashes of light at the beginning of the process, but a significant number of 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.
2-Conventional retinopexy.
3-Posterior vitrectomy with laser.
4-Posterior vitrectomy associated with intraocular injection of silicone oil.
5-The combination of the aforementioned surgery.

Only with the examination of the eyes can determine what is the severity and type of surgery to perform. It is important to know if the detachment of the retina is an ophthalmological emergency, as soon as the patient is operated on, the greater the probability of recovery of the vision.