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The diabetes mellitus is one of the most widespread diseases, more than 5% of the population of the globe suffer from it. At a diabetes mellitus in blood at the patient sugar level increases that influences a condition of all blood vessels in an organism, as well as on retina vessels. Damage of a retina at a diabetes mellitus is called a diabetic retinopathy which is the main reason of a blindness and loss of working capacity.
In development of a disease an important role is played by age of the patient. If the diabetes mellitus was diagnosed till 30 flyings, then the frequency of a disease of a retinopathy increases: in 10 flyings — for 50%, in 20 flyings — for 75%. If diabetes began after 30 flyings, then the retinopathy develops quicker and can be shown in 5-7 flyings at 80% of the diseased. The disease affects patients with both insulin-dependent, and non-insulin-dependent type of diabetes.
Stages of a diabetic retinopathy
The diabetic retinopathy consists of several stages. The initial stage of a retinopathy is called neeproliferativny, and is characterized by emergence of microaneurysms which expands arteries, dot hemorrhages in an eye in the form of dark stains of rounded shape or shtrikhoobrazny strips, emergence of ischemic zones of a retina, retina hypostasis in macular area, and also a hyperpermeability and fragility of walls of vessels. In this case through the thinned vessels the liquid part of blood leading to formation of hypostasis gets into a retina. And if the central part of a retina also is involved in this process, then decrease in sight is observed.
It is necessary to notice that this form of diabetes can arise on any term of a disease, and represents the initial stage of a retinopathy. If not to treat her, then there is a transition to the second stage of a disease.
The second stage of a retinopathy — proliferative which is followed by disturbance of blood circulation in an eye retina that results in deficit of oxygen in a retina (air hunger, ischemia). For recovery of level of oxygen the organism creates new vessels (this process is called neovascularization). Again formed vessels are damaged, and begin to bleed therefore blood gets to the Vitreous, retina layers. Thereof appears floating opacities in eyes against decrease in sight.
At late stages of a retinopathy at continuation of growth of new vessels and cicatricial fabric, can lead to amotio of a retina and development of glaucoma.
The insufficient amount of insulin is a basic reason of development of a diabetic retinopathy that leads to accumulation of fructose and sorbitol, promoting increase of pressure, a thickening of walls of capillaries and narrowing of their gleams.
Symptoms of a diabetic retinopathy
The main symptoms of a retinopathy depend on a disease stage. Usually patients complain of blurring of sight, emergence of floating dark opacities in an eye (midges), and sharp loss of sight. It is important to note that sharpness of sight depends on sugar level in blood. However at initial stages of a retinopathy of visual frustration it is practically not observed therefore patients with diabetes have to pass regularly ophthalmologic survey for identification of the first symptoms of a disease.
Diagnosis of a diabetic retinopathy
The people suffering from a diabetes mellitus have to pass regularly inspections of eyes thanks to what there is an opportunity to reveal developments eye complications at early stages, and to begin timely treatment. Diabetics have to be under continuous supervision not only the therapist and the endocrinologist, but also and the ophthalmologist.
The diagnosis a diabetic retinopathy is made on the basis of complaints of the patient to decrease in sight and on survey of an eyeground by means of the ophtalmoscope. Oftalmoskopiya allows to reveal pathological changes of an eyeground. Determination of level of intraocular pressure, biomicroscopy of front department of an eye belong to ophthalmologic researches.
Besides funduskamer who allow to document changes on an eye retina carry out photography of an eyeground with the help, and also a fluorescent angiography for definition of localization of vessels from which liquid is emitted and macular hypostasis is caused. The biomicroscopy of a crystalline lens is carried out by means of a slit lamp.
Treatment of a diabetic retinopathy
Treatment of a retinopathy depends on severity of a disease and consists of a number of medical procedures.
At the initial stages of a disease therapeutic treatment is recommended. In this case long administration of drugs, the capillaries reducing fragility — vasoprotectives (Dicynonum, Parmidinum, predian, Doxium), and also supervision over maintenance of level of sugar in blood is appointed. For prevention and treatment of vascular complications at a retinopathy it is appointed also sulodeksid. Besides, vitamin P, E, ascorbic acid, and antioxidants, for example, of Striks whose part extract of bilberry and beta carotene is is used. This drug strengthens a vascular grid, protects them from action of free radicals, and improves sight.
If diagnosis of a diabetic retinopathy shows serious changes, such as neovascularization, hypostasis of the central zone of a retina, a retinal apoplexy, then it is necessary to start quickly laser treatment, and in started a case — band surgery.
In case of hypostasis of the central zone of a retina (makula) and formation of the new bleeding vessels, demands carrying out laser coagulation of a retina. During this procedure laser energy is brought directly to the damaged places of a retina through a cornea, moisture of an anterior chamber, a vitreous and a crystalline lens without cuts.
The laser can be also used for cauterization of areas of a retina out of a zone of the central sight which test air hunger. In this case the laser ischemic process in a retina therefore new vessels are not formed collapses. Also cleans uses of the laser already educated pathological a vessel that leads to reduction of hypostasis.
Thus, the main objective of laser coagulation of a retina is to interfere with progressing of a disease, and for achievement of it coagulation sessions which are carried out with an interval in several days are usually held a little (on average 3-4) and 30-40 minutes last. During a session of laser coagulation there can be painful feelings at which the local anesthesia in the fabrics surrounding an eye can be used.
In several months after the end of treatment carrying out a fluorescent angiography for definition of a condition of a retina is appointed.
Cryocautery of a retina is carried out if at the patient strong changes of an eyeground are observed, it is a lot of fresh hemorrhages, neogenic vessels and if laser coagulation or a vitrectomy is impossible.
If at the patient with not proliferative diabetic retinopathy the vitreous hemorrhage which does not resolve (hemophthalmia) develops, then the vitrectomy is appointed. It is desirable to perform this operation at early stages that considerably reduces risk to receive complications of a diabetic retinopathy.
During a vitrectomy the doctor deletes a vitreous and the blood which accumulated here, and replaces him with saline solution (or silicone oil). At the same time hems which cause gaps and peeling of a retina are dissected and the laser (diathermocoagulator) cauterizes the bleeding vessels.
In therapy of such disease as a diabetic retinopathy a specific place is held normalization of carbohydrate metabolism since the hyperglycemia promotes progressing of a disease. It occurs by purpose of glucose-lowering drugs. Also important role is played also by normalization of a diet of the patient.
Treatment of a diabetic retinopathy has to be carried out by joint efforts of the ophthalmologist and endocrinologist. At timely diagnosis and complex treatment there is every chance to keep sight and full public and private life.
Prevention of a diabetic retinopathy
Prevention of a retinopathy is maintenance of normal level of sugar in blood at diabetics, optimum compensation of carbohydrate metabolism, control of arterial pressure, correction of a lipidic exchange. It allows to reduce possible complications from eyes.
The healthy nutrition and regular exercise stresses positively influence the general condition of patients with a diabetes mellitus. It is also important to pass regular surveys at the ophthalmologist. Timely prevention of a diabetic retinopathy and damages of eyes, at a diabetes mellitus, very important. As at late stages of a disease treatment is not effective. However, because at the initial stages of a retinopathy of visual frustration it is not observed, patients ask for the help when there are already extensive hemorrhages and changes in the central zone of a retina.
Complications of a diabetic retinopathy
The main complications of diabetic damage of eyes are traction amotio of a retina, emergence of a gemofalm, and also secondary neovascular glaucoma which treatment demands an operative measure.
Section: Diseases of eyes