Diabetes is a metabolic disease based on reduced ability or complete inability of pancreas to produce enough insulin (pancreatic hormone). Therefore, without insulin, the cell cannot utilize the glucose from blood and a lot of glucose stays in circulation (hyperglycemia), but not enough in cell itself, where it is necessary for life. In circulation, on the contrary, hyperglycemia produces a lot of changes in the blood vessels, small and bigger (micro- and macro-circulatory damages). The results of these are ischemic changes in almost all tissues and organs (renal function damage, heart, brain, periphery neuropathy, skin – delayed healing, and damages in the eye). Diabetic changes are typical and easy to discover by examining the eye fundus. It is not rare that the ophthalmologist is the first to discover and to consider the diabetes mellitus, when the clinical picture is not fully presented.
In non-treated long lasting hyperglycemia, biochemical changes lead to damages in almost all blood vessels, and by time, that leads to changes of quality and permeability of blood vessels. On the basis of ischemic changes, a lot of growth factors are produced, and therefore, new blood vessels (neovascularization-NV) appear. But these blood vessels are very fragile and in clinical picture we can see bleeding, blurred vision, macular oedema, fibrovascular membrane forming, with traction on retina, and by time, retinal detachment (diabetic retinopathy). Cataract is very common in diabetic patients (metabolic cataract).
TREATMENT
In ophthalmic treatment of diabetic retinopathy, we use aVEGF therapy, intravitreal, to reduce the oedema and bleeding and to lower angiogenesis. In a few days, the patient feels little clearing (prompt effect), and in a few weeks neovascularization is reduced (delayed effect). Unfortunately, there is a need for repeated treatment.
The patient should follow the instructions of endocrinologist, as well.
Laserfotocoagulation is still very often used for treatment of pre-proliferative diabetic retinopathy, but it should be used on the periphery of retina or around macula, because it leaves the thermal spot and it is dangerous to be used directly on macula. After laser treatment patient can feel temporarily blurred vision. Therefore, for macular oedema, aVEGF therapy is better option. Sometimes, it is necessary to combine these 2 procedures. With good treated diabetic retinopathy, the moment of vitreoretinal surgery could be postponed and that leads to better control of bleeding during the operation. In the case of intensive opacity and traction, vitreoretinal surgery should be performed, before retinal detachment appears.
Vitreoretinal surgery performed on time, with good preoperative treatment is a good way to save the visual function.
Vitreoretinal surgery in SVETI VID is performed on very high level, with the new operative techniques and instrumentation, in miniinvasive manner, in one-day surgery, it is very comfortable for the patient, with very good results.