Treatment Of Diabetic Retinopathy

If you have mild NPDR, you may not require treatment right away. However, your eye doctor will need to closely monitor your retina. More advanced forms of retinopathy often require prompt surgical treatment. The two main treatments for diabetic retinopathy are photocoagulation and vitrectomy. In a majority of cases, these treatments are effective and slow or stop the progression of the disease for some time. But they're not a cure. Because diabetes continues to affect your body, you may experience further retinal damage and vision loss at a later time.

Treatment Of Diabetic Retinopathy

Photocoagulation

The goal of photocoagulation is to stop the leakage of blood and fluid in the retina and thus slow the progression of diabetic retinopathy. The decision to use the procedure will depend on the type of diabetic retinopathy you have, its severity and how well it may respond to treatment. Photocoagulation may be recommended if you have:

• Macular edema, a swelling that involves or threatens the center of the retina
• Severe NPDR, especially if you have type 2 diabetes
• PDR 
• Neovascular glaucoma 

In photocoagulation a high energy laser beam creates small burns in areas of the retina with abnormal blood vessel to seal any leaks. The procedure takes place in a doctor's office or an outpatient surgical center. Before surgery your eye doctor will dilate your pupil and apply anesthetic drops to numb your eye. In some cases he or she will numb the eye more completely by injecting anesthetic around and behind the eye.

With your chin and forehead resting in a slit lamp, a medical contact lens is placed on your cornea to help focus laser light onto the sections of the retina to be treated. Fluorescein angiographic photographs may serve as maps to show where the laser burns should be placed. During the procedure you may see bright flashes from the short bursts of high energy light.

To treat macular edema, the laser is focused on spots where blood vessels are leaking near the macula. The doctor makes "spot welds" to stop the leakage. If the leaks are small, the laser is applied directly to specific points where the leaks occur (focal laser treatment). If the leakage is widespread, laser burns are applied in a grid pattern over a broad area (grid laser treatment).

Shortly after laser treatment, you can usually return home, but you won't be able to drive, so make sure to arrange for a ride. Your vision will be blurry for about a day. You may have some eye pain or a headache and be sensitive to light. An eye patch and over-the-counter pain relievers should help to ease the discomfort.

Even when laser surgery is successful in sealing the leaks, new areas of leakage may appear later. For this reason you'll have follow-up visits and, if necessary, additional laser treatments.

Immediately following laser surgery to treat macular edema, small spots caused by the laser burns may appear in your visual field. The spots generally fade and disappear with time. If you had blurred vision from macular edema before surgery, you may not recover completely normal vision.

Vitrectomy

Often a vitreous hemorrhage will clear up on its own. But photocoagulation treatment will be impossible if the hemorrhage is massive and doesn't clear. That's when a vitrectomy becomes necessary to restore sight or prevent total loss of vision. Early vitrectomy is especially beneficial for people with complications of type 1 diabetes.

In this procedure the surgeon uses delicate instruments to remove the blood-filled vitreous. A vitreous cutter cuts the tissue and removes it, piece by piece, from the eye. An infusion cannula, or tube, replaces the volume of removed tissue with a balanced salt solution to maintain the normal shape and pressure of the eye. A light probe illuminates the inside of the eye. The surgeon performs the procedure while looking through a microscope suspended over the eye. In this way the vitreous blood is removed to re-establish clear vision.

A vitrectomy is also used to remove scar tissue when it begins to pull the retina away from the wall of the eye. This allows a detached retina to settle back and flatten out. Your eye doctor may decide not to operate on a retina detached by scar tissue if the detachment is located away from the macula and doesn't appear to be progressing.

During a vitrectomy the surgeon may also perform panretinal photocoagulation with a laser probe. This can prevent renewed growth of abnormal blood vessels and bleeding.

Vitrectomy is usually done under local anesthesia on an outpatient basis. Your eye will be red, swollen and sensitive to light for some time after surgery. For a short time afterward, you'll need to wear an eye patch and apply medicated eyedrops to help the healing.

Treatment Of Diabetic Retinopathy

Full recovery may take weeks. When a vitrectomy is done for PDR with a massive vitreous hemorrhage, some blood may remain in the eye, or fresh bleeding may occur. It may take several weeks for your sight to clear.

Following a vitrectomy for traction retinal detachment or vitreous hemorrhage, vision improves in most people. When surgery fails to improve vision, it's usually because of irreparable damage to the retina from diabetes. But at times it can be due to complications of the surgery, recurring vitreous bleeding, retinal detachment or formation of new blood vessels on the iris (neovascular glaucoma). To find out more, you can check out Treatment Of Diabetic Retinopathy.