Wednesday, July 20, 2011

Diabetes Mellitus as a Cause of Blindness

Diabetes - a disease characterized by impaired endocrine metabolic processes of the body. One of its complications - is diabetic retinopathy (damage of the retina).

The prevalence of diabetic retinopathy is 90% of those with diabetes type I and 38.9% of those with diabetes type II.

The cause eye damage in diabetes
With prolonged and uncompensated (when higher than normal sugar), diabetes, retinal damage occurs - diabetic retinopathy.

What are the causes of this disease?
In diabetes disturbed metabolism of carbohydrates (sugars) and fats (triglycerides and cholesterol). These substances are not absorbed by the body for a long time and remain in the blood, damaging the lining of blood vessels (endothelium). As a result of microvascular damage - in the past formed clots, narrowing their clearance and as a result, there is a lack of oxygen to tissues and organs (called ischemia). If ischemia persists for a long time, irreversible changes in the affected organs - they atrophy (if there was a gradual decrease in blood flow) or infarction (with a sharp decrease in blood supply to any part or organ). In the body there is a compensation mechanism of ischemia - education about the blockage of new blood vessels. But the problem is that the newly formed vessels are not full - their walls thin, endothelial lining with defects that lead to undesirable consequences:

- Swelling of tissue due to passage through the vascular wall of blood plasma
- Bleeding in the retina (even with a slight increase in blood pressure)
- The deposition in the tissues of organic matter (formation of hard exudates)
- Retinal detachment
- Bleeding into the vitreous

The manifestations of diabetic retinopathy:
- Gradual reduction of vision is not improving after spectacle correction

- The appearance of dark spots in the field of view

- A sharp sudden decrease of
Diagnosis of Diabetic Retinopathy:
- Ophthalmoscopy (fundus examination) can detect retinal edema, exudates, microbleeds on the retina, vitreous hemorrhage, the newly formed blood vessels.

Fluorescence angiography (study of blood flow to the retina) reveals the ischemic zone, the newly formed blood vessels, retinal vascular occlusion.
- Optical coherence tomography - at the cellular level defines the retinal lesions.
Treatment of diabetic retinopathy:
Drug treatment is carried out ophthalmologist in an outpatient or inpatient setting and has the following objectives:

1. compensate for diabetes - when blood sugar levels will be kept at a high level, there is no long-term effect of treatment should be expected. For this purpose, appointed by the consulting endocrinologist.
2. Improve blood flow through the vessels of the retina
vasodilators Pentoxifylline (Pentoxifylline)
Antiplatelet Acidum acetylsalicylicum (Aspirin)
3. Antioxidant therapy:
Vitamin E
Methylethylpiridinol (emoksipin)
4. Angioprotective therapy (medicines strengthen the vascular wall)
Acidum Ascorbicum (Vitamin C)
Etamsylate (etamzilata)
5. Improvement of metabolic processes of the retina (retinal preparations containing the necessary trace elements and vitamins)
Retinalamin
Trimethylhydrazinium propionate (Mildronate)
Wobenzym

Surgical treatment is performed in a hospital:
Laser coagulation of the retina - is to reduce the swelling of the retina. Is to apply laser-coagulants on the retina - formed through the pores of the liquid, creating a swelling of the retina, an additional outflow of preretinalnoe space.

- Injection drug (Avastin, Lucentis) in the vitreous. These drugs at the molecular level, blocking the vascular growth factor, preventing the appearance of newly formed blood vessels, contribute to the disappearance of already appeared.
- Surgery on the retina - vitrectomy is used when the long-term absorbable hemorrhages into the vitreous.

Diabetic retinopathy is a terrible complication, potentially leading to complete blindness. For the treatment of this disease requires constant monitoring of blood sugar and blood cholesterol, maintaining blood pressure within normal limits and timely assistance ophthalmologist. If exposed to diagnose diabetic retinopathy, the ophthalmologist inspections should be carried out at least 2 times a year.

2 comments:

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