Diabetic retinopathy remains a prevalent cause of blindness even though it is largely preventable by medical maintanence and preventative screening therapy. However, since many cases of retinopathy are not diagnosed or acknowledged until the later stages of proliferative retinopathy and macular edema, there are several surgical and pharmacological methods to treat the symptoms of diabetic retinopathy. It is important to note that the treatments and therapies are only effective at treating the symptoms of diabetic retinopathy but cannot actually cure the patient. Since the retinopathy is a complication of diabetes, control of diabetic symptoms is vital to fighting the disease.
Current treatments of the symptoms of retinopathy include laser photocoaglulation, treatment with injections of triamcinolone, and vitrectomy.
Laser Photocoagulation consists of various surgical laser treatments done by a certified opthamologist. The laser can be focused in specific spots to create burns and specifically target abnormal blood vessels. A scatter technique may also be used to generally focus the laser over the retina to destroy the abnormal blood vessels and make them contract. Since proliferated diabetic retinopathy is continuous further bleeding can and most probably will continue to develop as may glaucoma requiring multiple treatments.
The figure is a representative of focal laser photocoagulation where the laser is being focused onto various specific spots determined by the opthamologist targeting the affected blood vessels. Laser photocoagulation, as successful as it is in the removal of abnormal blood vessels, it is an uncomfortable if not painful procedure which can have complications which including blurriness, and a distinct pain and discomfort caused by the laser treatments. Patients also report on seeing bright flashes of light during the procedure.
Triamcinolone is a cortical steroid that can be injected into the retina which can decrease the macular edema by reducing its swelling. Since it is a pharmacological treatment, it has to be applied more frequently but can be gentler than the laser photocoagulation. Nowadays, various pathways to treatment are available to the patient: commonly photocoagulation, which is highly effective on decreasing abnormal vessel size is used in unison with intravitreal triamcinolone, which is proven to be highly effective at reducing macular edema.
As can be seen by the figure from repeated treatments of triamcinolone visual acuity greatly improved from prolonged treatment as seen by lessened macular edema. It is important to note that every treatment also has potential complications. It is possible to be affected by an increase in interocular pressure which can result in secondary open angle glaucoma. This pressure inside the eye can reach as much as 24 mm Hg. Another frequent complication of Triamcinolone treatment is the formation of cataracts which can be visually detected over a course of six months to a year after the treatment. []
Vitrectomy A vitrectomy is an older technique which is commonly done when there is a lot of blood in the humor. The process is to essentially replace the particle blocked vitreous with a saline solution. Since saline is similar to the natural vitreous humor, there should be a similar optical environment.
The key is to make as small an incision possible and then to drain the vitreous humor. This process is done using general anesthetic to stabilize the patient as the microsurgery occurs. A small flap is made in scelra and a tube that removes the cloudy vitreous humor. The humor is then replaced with a saline solution.
The figure is the process of an actual vitrectomy, which can not only dramatically clear vision and remove the floating blood in the humor, the process of the vitrectomy also removes the scaffold layer which is necessary for future blood cell development. []