Management of Diabetic Retinopathy
Chronic hyperglycemia is the cause of the diabetic retinopathy (DR) that occurs in diabetes. The diseased tissue of the retina provokes the growth of new vessels from adjacent ones in an attempt to revascularlize it. Therein is the problem: neovascularization engenders the risk of hemorrhage and tractional retinal detachment.
The importance of early diagnosis of DR makes more likely any benefits from its management and treatment. Treatment is based on whether the retinopathy is nonproliferative (NPDR) or proliferative (PDR).
Nonproliferative Diabetic Retinopathy (NPDR) Treatment
Macular changes are the main cause of visual loss in NPDR. Macular edema or ischemia, when severe, are treated by using intravitreal antivascular endothelial growth factor (VEGF) in the eye under anesthesia. Alternately or in combination, laser photocoagulation can seal suspicious blood vessels before they hemorrhage or create traction on the retina. The goal of treatment is preservation of remaining vision while reducing progression. Macular edema also responds to injected steroids as a treatment alternative.
Proliferative Diabetic Retinopathy (PDR) Treatment
This more progressive condition mandates more aggressive treatment. Panretinal photocoagulation is the primary treatment for severe PDR and has been shown to reduce visual loss significantly.
If retinal detachment occurs, removal of the vitreous (“vitrectomy”) helps reach the goals of therapy by stabilizing the intraocular environment.
Anti-VEGF inhibitors are useful, also.
Complications of panretinal treatment:
- The increased intraocular pressure of a temporary glaucoma
- Corneal abrasions
- Macular edema, loss of visual acuity, loss of dark adaptation
In this aggressive treatment, the benefit outweighs the risks.