Diabetic retinopathy is a major ocular complication of diabetes and one of the four major blindness-causing eye diseases in China. In recent years, the incidence and blindness rate have increased significantly. According to statistics, 7% of people with a 10-year history of diabetes have retinopathy, about 25% of those with 15 years, and the incidence is 60% for 20-year type 2 diabetics who take oral hypoglycemic drugs and 84% for those who inject insulin. Diabetes mellitus is a multisystem disease with disorders of glucose metabolism as the main cause, which easily leads to disorders of retinal tissue metabolism, resulting in abnormal retinal vascular function and structure. Therefore, in order to avoid the occurrence of complications, it is important to understand its early symptoms and early detection and treatment.
(I) Clinical symptoms
In the early stage of retinopathy, there are generally no ocular symptoms, but with the development of the disease, there can be different manifestations. Patients feel that their visual acuity decreases, retinal edema causes light scattering and makes patients feel a flash in front of the eyes, macular edema, ischemia or exudation involves the central recess, which can cause different degrees of visual field central dark spot, central vision loss and visual distortion, etc. Retinal small artery rupture, a small amount of bleeding into the vitreous, which can make Patients can feel black shadows floating in front of their eyes, neovascularization, massive vitreous hemorrhage or proliferative vitreoretinopathy and tractional retinal detachment, which can lead to severe loss of vision and even blindness.
(b) What tests should be done for diabetic retinopathy?
1, Fundus fluorescence angiography (FFA) Fundus fluorescence angiography not only can understand the early changes of retinal microcirculation, but also has various special manifestations in the progress of diabetic retinopathy, which is a reliable basis for early diagnosis, selection of treatment plan, evaluation of efficacy and prognosis.
2.Optical coherence tomography (OCT) Optical coherence tomography can clearly show the morphological characteristics of the posterior segment of the eye, mainly the macula and the optic papilla, the structure of the retinal layers, and the thickness changes of the retina and its nerve fiber layer, which can objectively evaluate the degree of diabetic macular edema.
3.Electroretinogram oscillatory potentials (OPs) OPs is a subcomponent of electroretinogram (ERG), which can objectively and sensitively reflect the state of blood circulation in the inner layers of the retina. In eyes without fundus lesions, it can reflect the abnormal amplitude of OPs, and in patients with diabetic retinopathy, it can further show the progression and improvement of the disease process.
4. Other examinations such as visual contrast sensitivity examination, fundus photography examination, etc.
(iii) What are the complications of diabetic retinopathy?
Neovascular glaucoma, vitreous hemorrhage, retinal detachment, etc. Therefore, effective control of diabetes mellitus, treatment of hypertension and systemic vascular diseases such as heart and kidney should be actively carried out to change microcirculation, avoid deterioration of retinopathy and preserve vision.
(IV) Treatment
Early lesions usually do not require special treatment, but close ophthalmic follow-up should be performed to keep abreast of changes in eye conditions and to actively control blood glucose levels to prevent further development of eye lesions. If hemorrhage and neovascularization appear in the fundus, then fundus fluorescence angiography should be performed in a timely manner to check for the presence of nonperfused areas, and if the extent is 5 optic disc sizes, then retinal photocoagulation should be performed in a timely manner to prevent further development of the lesion. For patients with more severe proliferative diabetic retinopathy, such as repeated massive hemorrhage in the fundus, large fibrous proliferative membrane or retinal detachment, vitrectomy should be performed as soon as possible to avoid irreversible visual impairment.
1.Medication
(1) Long-term control of diabetes: The fundamental treatment of diabetic retinopathy is to treat diabetes. In principle, blood glucose should first and often be controlled to normal or near normal levels. If the blood sugar and systemic condition of diabetic patients are well controlled, it is certainly beneficial to delay the occurrence, progression and reduction of diabetic retinopathy.
(2) Lower blood lipids: For diabetic patients with high blood lipids and ring-shaped hard exudates in and around the retinal macula, they should consume a low-fat diet and apply lipid-lowering drugs: such as heparin and clobetine.
(3) Blood pressure control: elevated blood pressure can aggravate diabetic retinopathy, and when hypertension is controlled, fluorescence leakage is significantly reduced, so blood pressure should be controlled in patients with diabetes combined with hypertensive disease.
2.Photocoagulation therapy
Laser therapy is considered to be an effective method for treating diabetic retinopathy. Clinical trials have demonstrated that photocoagulation therapy has beneficial effects on the pathogenesis of the disease in 2 ways: firstly, it causes degeneration of neovascularization and prevents their regeneration; secondly, it reduces macular edema. The former is for proliferative lesions and the latter is for non-proliferative lesions.
3.Vitreous dissection
For diabetic retinopathy, the basic indications for vitrectomy are severe proliferative lesions and extensive vitreous hemorrhage that cannot be spontaneously absorbed for more than 3 months.
The prognosis for early diagnosis and treatment of diabetic retinopathy is good. Once comorbidities occur such as neovascular glaucoma, macular degeneration and retinal detachment, the prognosis is poor. Medication is the root of the disease, and diet can assist in the treatment of medication, so what is the diet and diet for diabetic retinopathy?
(f) What is the best food for diabetic retinopathy?
Diabetic retinopathy diet principles.
(1) The supply of protein should be sufficient:
(2) Reasonable control of total calories.
(3) Food should be rich in dietary fiber.
(4) Carbohydrates should not be controlled too tightly.
(5) Reduce fat intake.
(6) Appropriate supplementation of vitamins, minerals and trace elements: pay special attention to vitamin B1, vitamin B12, vitamin C
(7) What is the best thing for diabetic retinopathy patients not to eat?
Avoid spicy and fried foods, sweet things such as white sugar, brown sugar, icing sugar and sweet snacks, sweet drinks and other sugary products, fruits, potatoes, roots and other foods should also be controlled. Drinking water need not be too restricted. The sodium in the diet should not be too much
(H) Prevention
Diabetic retinopathy has irreversible damage to visual function, so prevention of the disease is especially important, and reasonable control of blood sugar is the key to prevent diabetic retinopathy. It is especially important to prevent the liver and kidney function from being affected. When the liver and kidney function is abnormal, the recovery of the disease is not good even if surgery is performed. The next step is to go to the ophthalmology department regularly for fundus examination according to the degree of lesion, and find abnormalities and deal with them in time!