Diabetes
Diabetes

Diabetic retinopathy

click fraud protection

Among the complications that occur in people with diabetes, both first and second type, the most serious and dangerous is diabetic retinopathy. The term "diabetic retinopathy" refers to as a visual impairment due to vascular damage to the eyes, resulting in a reduction, and sometimes even a complete loss of vision, of the .In type I diabetes, with a history of disease of about 20 years or more, visual complications are noted in 85% of patients. In the detection of type II diabetes, approximately 50% already have such disorders.

Classification of

Retinopathy

Depending on the stage of the disease, the nature of the pathological changes in the vessels and eye tissues, the following classification is accepted:

  • nonproliferative diabetic retinopathy;
  • pre-proliferative diabetic retinopathy;
  • proliferative diabetic retinopathy.

Mechanism of development of

The main source of energy for the full functioning of the body is glucose. Under the influence of insulin, the hormone of the pancreas, glucose penetrates into the cells, where it is processed. With diabetes, for some reason, there is a violation of insulin secretion. Unprocessed sugar accumulates in the blood, as a result there is a violation of metabolic processes in the body.

insta story viewer
It leads to blockage, damage to the vessels of various organs, including organs of vision. If you do not start correcting the high glucose level in diabetic patients in time, diabetic retinopathy begins to develop over time.

Causes of

The main cause of the pathology is the increase of sugar( glucose) in the blood for quite a long time.

Normally, the blood sugar level should not rise above 5.5 mmol / L on an empty stomach and 8.9 mmol / L after eating.

In addition, the onset of retinopathy is influenced by the presence of concomitant factors in patients with diabetes mellitus. They can not only provoke the formation of such a complication, but also accelerate its course.

Factors:

  • increase in blood sugar;
  • persistent hypertension( increased blood pressure);
  • pregnancy;
  • various pathologies and kidney diseases;
  • is overweight;
  • smoking;
  • alcohol;
  • age-related changes in the cardiovascular system;
  • is a genetically predisposed predisposition.

The stages of retinopathy

Stages of retinopathy

The current course of the disease is divided into four stages, each of which lasts quite a long time. There is an exception - with juvenile( juvenile) diabetes, loss of vision can develop within a few months.

Stages of retinopathy in diabetes mellitus:

  • I st.non-proliferative - is characterized by the appearance of minor local extensions of the retinal capillaries, as well as the emergence of solid exudative foci( lipid accumulations).Pointed hemorrhages appear in the central region of the fundus. Such changes can be observed in the deep layers of the retina, localizing along the course of larger vessels, veins. The retina swells.
  • II Art. Pre-proliferative - the changes become clear. Vessels clog, become more convoluted, double, their thickness is noticeably changed and can fluctuate. The number of hard exudative foci and hemorrhages increases, irreversible processes occur in the nerve fibers, which can lead to necrosis, adding new "cotton" exudates. The retina, which lacks nutrients and oxygen as a result of blood flow disturbance, sends out signals for the formation of new( abnormal) blood vessels.
  • III st.proliferative - in places of hemorrhage, a fibrous tissue is formed, the blood enters the vitreous. Anomalous thin vessels with fragile, fragile walls grow over the retina and vitreous body. Newly formed vessels often burst, which leads to repeated hemorrhages, as a result of which the retina exfoliates. The localization of such neoplasms in the iris of the eye can lead to the appearance of secondary glaucoma.
  • IV Art.terminal - frequent and profuse hemorrhages in the vitreous humor block vision. The increased number of blood clots stretches retina tissue and can lead to its exfoliation. The loss of vision occurs when the lens stops focusing light on the macula.

Symptoms of

The early stages of the disease are asymptomatic. Gradually appearing violations:

  • flashing "flies" in front of eyes,
  • appearance of "stars" and light misting,

These are the first symptoms that do not cause the patient any discomfort and discomfort. Such symptomatic manifestations are taken for fatigue, they are not given attention.

Eye pain, decreased visual acuity, as well as its loss - late symptoms, appear with the progression of pathology at later stages, when the process has gone too far or passed into the stage of irreversibility.

These symptoms indicate that any healthy person simply needs to come to an ophthalmologist at least once a year, and a diabetic patient every six months, to examine the organs of vision. This will detect the symptoms of the disorder in the early stages of the disease, without waiting for the emergence of obvious symptoms, when the treatment with medications can already be ineffective.

Diagnosis

Examination

When visiting an ophthalmologist, the doctor will conduct a visual examination using all the techniques to identify the earliest signs of the disease that occur without the appearance of early symptoms.

Methods of examination:

  • visometry - visual acuity check using the table;
  • gonioscopy - the definition of the angle of view of each eye, when the cornea is affected, it changes;
  • ophthalmoscopy in direct, as well as inverse form - examination of the lens, vitreous body for transparency;
  • study of transmitted light - evaluation of the state of choroid, optic disc, retina;
  • Ophthalmoscope - helps to identify early changes in the fundus;
  • biomicroscopy - examination of all structures of the eye with their increase up to 50-60 times using a slit lamp;
  • tonometry - measurement of intraocular pressure.

Treatment of

Since diabetic retinopathy develops against the background of metabolic disturbances in the body due to the presence of diabetes, the patient is prescribed a comprehensive treatment of diabetic retinopathy under the supervision of the oculist and endocrinologist. B A great role in the treatment of pathology is properly selected by specialists diet and insulin therapy.

Insulin therapy is aimed at compensating for carbohydrate metabolism disorders, it is selected strictly individually. Correctly selected technique of insulin therapy and its timely application significantly reduces the risk of the onset and progression of the pathological process. To choose a suitable technique, the kind of insulin and its dosage can only the doctor-endocrinologist, relying on the results of specially conducted tests. To adjust insulin therapy, most likely, you will need to place the patient in a hospital.

Therapeutic diet

People with this disease should adhere to proper nutrition, which is one of the main methods of complex therapy

. Excluded:

  • sugar, replacing it with substitutes( xylitol, sorbitol);
  • baking and puff pastry products;
  • bread of the highest and first grades;
  • fatty meat, fish;
  • sweet curd desserts and curds, cream;
  • smoked products;
  • pasta, semolina, rice;
  • fat concentrated broths, soups, cooked on milk with cereals, noodles;
  • spicy seasonings, sauces, spices;
  • sweet carbonated and non-carbonated drinks, juices, including grape;
  • honey, ice cream, jam

Recommended for use:

  • gray, best rye, and also bran bread;
  • low-fat meat, poultry, fish - boiled and flooded;
  • buckwheat, oatmeal, or pearl barley( due to bread restriction);
  • per day you need to eat no more than two eggs soft-boiled or in an omelette;
  • cheese, sour cream only in limited quantities;
  • berries such as cranberries, black currants or compotes of them, unsweetened apples, but not more than 200 grams per day;
  • tomato and other unsweetened fruit and berry juices;
  • coffee must be replaced with chicory.

Of particular importance is the phytodite. In patients with diabetes mellitus, acidification occurs in the body, which is why the use of vegetables with an alkaline effect is recommended:

  • zucchini;
  • eggplant;
  • cucumbers;
  • pumpkin;
  • Jerusalem artichoke.

Drink birch juice in half a glass to three times a day, fifteen minutes before eating.

Drug treatment

Medications

In medicamentous treatment the main place is occupied by:

  • preparations that lower blood cholesterol levels;
  • anabolic steroids;
  • antioxidants;
  • vitamins;
  • angioprotectors;
  • immunostimulants;
  • biogenic stimulants;
  • enzymes;
  • desensitizing drugs;
  • coenzymes and others.
  • Hypocholesterolemic drugs:
  • tribusponin;
  • .

These drugs are recommended for patients with diabetic retinopathy, which occurs in combination with general atherosclerosis.

  • Angioprotectors:
  • anginin;
  • parmidin;
  • doxium;
  • dicinone "or" Etamsylate;
  • trental;
  • pentoxifylline.
  • To treat the pre-proliferative stage of the pathology, the drug "Phosphaden" is used, which improves eye hemodynamics, general condition of the fundus and stimulating metabolic processes.
  • . Immunomodelling effect in the early stages of the disease is achieved by using Levemedil tablets, Tactivin and Prodigiozan injections.
  • Vitamins of group B, C, E, P.
  • Regenerating and improving metabolism in the eye tissues: preparations "Taufon", "Emoxipin".
  • Intraocular injection of enzyme preparations "Lidase", "Hemaz" is used in the presence of pronounced hemorrhages.

You can achieve a high result in treatment with the help of the physiotherapeutic apparatus "Sidorenko's glasses" that is convenient for use at home, which improves blood supply.

Unfortunately, drug treatment can be effective only in the initial stages of this type of retinopathy. In later periods of its development, laser therapy is used.

Laser coagulation allows you to slow down or even stop the process of growth of newly formed vessels, strengthens their walls and minimizes permeability. The probability of rejection of the retina is reduced.

With the started form of diabetic retinopathy, surgical intervention is required - vitrectomy.

Elimination of risk factors: stabilization of body weight, treatment of hypertension, withdrawal from alcohol and smoking helps restore metabolic processes, increases the result of treatment.

Folk methods of treatment

The initial stages of retinopathy can be treated fairly well by medicinal herbs, you can use folk remedies and at later stages in combination with medication.

If you drink lime-colored infusions instead of tea, you can lower the glucose level. Preparing the infusion is very simple: two tablespoons of lime blossom requires pour 0.5 liters of boiling water. Insist for about half an hour.

Collection "Genius" improves blood flow in the vessels of the retina, reduces the risk of retinopathy. Two tablespoons of the collection pour half a liter of boiling water, insist 3 hours, drain. Take 1/2 cup for ten minutes before meals 3-4 times a day. The course of treatment is up to 4 months.

Well restores the visual acuity of blueberries. Every day, 3 times a day, regardless of food intake, you should take one tablespoon of berries. At any time of year, frozen blueberries are sold in stores. It is also recommended to take infusions from the collections of herbs, which include this dried berry.

Related records
  • Share
Complications of type 1 diabetes
DiabetesDiabetes

Complications of type 1 diabetes

Diabetes mellitus itself is a fairly dangerous disease. This is due to possible complications that occur in the absence of adequate treatment. Wit...

Physical Exercises for Diabetics
DiabetesDiabetes

Physical Exercises for Diabetics

The exercise of exercise therapy for diabetes is very useful. Together with a low-carbohydrate diet for each day, they help control blood sugar, p...

Hypoglycemia: what is it and how to treat it?
DiabetesDiabetes

Hypoglycemia: what is it and how to treat it?

The condition when blood glucose levels go down is called hypoglycemia. It can develop very quickly, sometimes in a few minutes. In this case, wit...