Visual impairment as a complication of diabetes mellitus: mechanisms of development, treatment, prevention
Neurological disorders are an integral part of the clinical picture that characterizes diabetes mellitus. Often they appear even in the latent period of the disease. Their spectrum is diverse: peripheral, autonomic neuropathies, lesions of cranial nerves, disorders vision, spinal cord lesions, brain lesion syndromes, coma of various nature. Of the cranial nerves, the group of oculomotor nerves and the optic nerve are most often affected by prolonged hyperglycemia.
Prolonged hyperglycemia can lead to a variety of visual impairments: diabetic retinopathy, neuropathy optic nerve, retrobulbar neuritis, vitreous hemorrhage, retinal detachment, glaucoma, cataract. Diabetic retinopathy is the most common cause of vision loss. In addition, clouding of the lens often leads to a pronounced decrease in vision. In young patients, it is rare, but can develop forms of rapidly developing cataracts.
One of the common complications of diabetes mellitus is optic neuropathy. Deterioration of vision is observed with a long course of the disease, poorly controlled glucose levels, non-compliance with medical and preventive recommendations. It is noticed that the younger the patient's age, the more complications of diabetes from the organs of vision appear. earlier, their course is more severe, they progress faster, and often become one of the reasons disability.
At the heart of visual impairments, including neuropathy of the optic nerve, are primarily ischemic processes. It is known that prolonged hyperglycemia triggers a cascade of pathological changes: the accumulation of toxic glycation products, inflammation products, increased lipid peroxidation, resulting in changes in the endothelium and impaired permeability of the walls of the vessels of the fundus, hypoxia retina. Ischemic processes, in turn, themselves trigger oxidative stress and stimulate the formation of free radicals. A vicious circle ensues. Retinal ischemia triggers the proliferation of new vessels, but their wall is sufficiently fragile and prone to hemorrhage. Due to the violation of vascular permeability, the retina and the optic nerve head swell, small-point hemorrhages occur, microaneurysms and other vascular disorders, which as a result cause further retinal detachment and blindness. There is no doubt that the treatment and prevention of visual impairments is based on optimal compensation for hyperglycemia and normalization of carbohydrate metabolism. By regularly monitoring the level of glucose in the blood, it is possible to somewhat delay the occurrence of complications, to achieve stabilization of the process with an already arisen condition.
In addition, in the presence of complications from the organs of vision, one cannot do without medication. Used vasoactive drugs, neurometabolic drugs. To reduce the damaging effect of free radicals on cells, drugs with an antioxidant effect are used, in particular, thioctic acid preparations. It reduces the severity of ischemia and the pathological changes in tissues initiated by it, reduces the manifestations of oxidative stress and the damaging effect of free radicals. Thioctic acid preparations, in particular Thioctacid®BV, contribute to the restoration of other antioxidant systems and enhance their action, affect the level of glycemia, regulate carbohydrate and fat metabolism. Thioctic acid can be used at the very beginning of the disease, even before the clinical manifestations of complications from the organs of vision. Thioctic acid allows you to suspend the progression of visual impairments, and to delay the use of methods of surgical correction of visual impairment in diabetes mellitus.
Alina Safronova, ophthalmologist, Medical and Diagnostic Center of the General Staff of the Armed Forces of the Russian Federation, Moscow
