Diabetic retinopathyDR is a common complication of diabetes mellitus and one of the four major blinding eye diseases, and its incidence and blindness are increasing year by year.The occurrence and progression of DR is related to a variety of factors, and early diagnosis and active treatment to prevent or delay its progression is essential. To provide planned and purposeful health education to patients, to help people master health care knowledge, to motivate people to establish health awareness, to consciously adopt behaviors and lifestyles that are beneficial to health, to eliminate or mitigate risk factors that affect health, to raise awareness of self-protection against DR, to develop in a direction that is beneficial to health, and to improve the quality of life.
1.Self-monitoring of DR
1.1 The monitoring of blood glucose is most important to monitor fasting and 2h postprandial blood glucose. Several regions in China have been using intravenous plasma (or centrifuged serum) to measure blood glucose, for those who have light disease and satisfactory blood glucose control, it can be observed once a few weeks. In recent years, the application of pocket-sized fast capillary blood glucose meter has become more and more common, with this method can be operated by oneself and monitored.
1.2 Urine sugar monitoring is now commonly used method is urine sugar test paper method, which is simple, accurate and convenient to carry. In the application should pay attention to the test paper out, must be immediately corked tightly, in a cool and dry place to store, to prevent deterioration, expired. The time after the test paper touches the urine should be calculated accurately when measuring. The measurement of urine albumin should be done every year. A positive result often indicates that irreversible kidney damage has occurred, and checking albumin can detect trace proteinuria early, which can tell patients to be alert to kidney disease at an early stage.
Adjust the dosage of oral hypoglycemic drugs or insulin through the measurement of pre-meal glucose and urine glucose. Follow the doctor’s prescription and do not self-administer or stop the medication.
2.Prevent and control complications
2.1 Strictly control the occurrence and development of hypertension DR is related to hypertension, diabetes combined with hypertension patients are prone to retinopathy. Therefore, for the combination of hypertension should actively lower blood pressure, blood pressure is generally controlled below 140/90mmHg, to prevent the harmful effects of hypertension on the retinal circulation.
2.2 Prevent hypoglycemic reactions Explain to patients the symptoms of hypoglycemic reactions and the measures to be taken, especially before meals, at bedtime and after medication. If there are symptoms of hunger, dizziness, weakness, palpitation, sweating, rapid pulse, etc., some sugar water is needed; if there are symptoms of convulsion, coma, epilepsy, etc., intravenous injection of 50% glucose 20-40ml is needed.
3.Regular examination of fundus
Eye examinations should be routinely performed every year, and pathological changes in the retina and vitreous should be treated promptly to prevent bleeding and improve microcirculation. For mild and moderate non-proliferative retinopathy, laser coagulation therapy should not be done and should be closely observed. In more severe retinopathy, scattered laser coagulation therapy should be considered. This is a curative approach to reduce blindness. Vitrectomy is suitable for vitreous hemorrhage and tractional retinal detachment in the late stage of proliferative retinopathy.
4.Dietary care
Adjustment of diet is one of the necessary measures to treat DR. The main principle is to appropriately limit the daily carbohydrate intake to reduce the burden on the pancreas. Calculate the total calories according to gender, age, height, standard weight and labor intensity. Generally, patients should eat no less than 250g of staple food daily, and are allowed to choose to eat vegetables, such as spinach, celery and onion, as well as lean meat, eggs, soy milk, soy products and milk. Stir-fried vegetables should generally be made with vegetable oil, no sugar and less salt. Patients with mild disease can eat fruits with less sugar, such as pears, strawberries, prunes, loquats, pineapples, etc., as appropriate, while apples and bananas should not be eaten. Do not eat candy, preserves, pastries, etc.
5.Living health care
Pay attention to the regularity of life, pay attention to human hygiene and environmental hygiene; pay attention to rest and proper exercise; protect the skin cleanliness and avoid colds. Proper diet, appropriate exercise and take hypoglycemic drugs on time to prevent the occurrence of hypoglycemia, is an important part of reducing DR and preventing blindness.
6.Psychological care
Tension, anxiety, emotional excitement, psychological stress can affect the onset of DR and disease control. Because diabetes is a chronic lifelong disease, with the development of the disease appears multi-organ function impairment, bringing great economic and psychological pressure to patients and their families, patients due to control diet, long-term medication brought worries, fear of hypoglycemic symptoms and other side effects, anxiety and other adverse psychology, so that they lose confidence in life, negative, pessimistic, easily irritable, irritable, for the psychological characteristics of patients with DR, nurses should Close nurse-patient relationship, improve emotional communication, communicate nurse-patient psychology, win patients’ trust, give patients persuasion, advice, encouragement and support, stabilize emotions, and give patients guidance, care, encourage patients and their families to tell their feelings, patiently answer their questions, guide patients to release their fear and apprehension, so that patients maintain optimism and actively cooperate with treatment.
The fundamental treatment of diabetic retinopathy is to treat diabetes. When oral medication cannot effectively control the blood glucose level, insulin should be injected under the guidance of an endocrinologist.
Drug treatment
For background stage diabetic retinopathy, that is, stages I to III, dietary control and medication are generally used. A low-fat, high-protein diet and more vegetable oils can reduce hard exudate. Small doses of aspirin, which has anti-inflammatory effects and reduces platelet agglutination, are effective in diabetic retinopathy. Calcium hydroxybenzenesulfonate can reduce the hyperleakage reaction of diabetic retinal vessels, lower the high viscosity of blood and reduce the high aggregation of platelets, which also has a certain therapeutic effect on diabetic retinopathy. As a result of the wisdom of traditional medicine in China, Chinese medicines (e.g., Fuxiang Danxiong tablets and other blood-activating drugs) also have clear efficacy in diabetic retinopathy and can slow down the progression of diabetic retinopathy. When macular edema is present in the fundus, local treatment with long-acting hormones, such as subconjunctival or intraocular injections of tretinoin, can also be used, which has clear efficacy in reducing edema and improving vision, but the side effects of treatment, mainly secondary glaucoma and the risk of intraocular infection, should be weighed before treatment. When vitreous hemorrhage is present, hemostatic medications such as Yunnan Baiyao can be administered, and medications to aid absorption, such as lecithin complex iodine (Volitene), can be given.
While the effectiveness of short-term blood glucose control on fundus pathology is sometimes not easily seen, the effectiveness of long-term maintenance of blood glucose at normal levels in preventing diabetic retinopathy is well recognized. Some studies have shown that a 2% decrease in glycosylated hemoglobin can reduce the progression of diabetic retinopathy by 70%. In addition, if the overall blood glucose level is comparable, diabetic retinopathy is likely to worsen if the blood glucose fluctuates more, so it is very important to maintain a stable normal blood glucose level.
Laser treatment
For more severe diabetic retinopathy, laser photocoagulation is an effective treatment. In background stage diabetic retinopathy, laser treatment mainly treats macular edema and ring exudate lesions, which can reduce the incidence of persistent macular edema, decrease the risk of degeneration and vision loss, and facilitate the recovery of visual acuity. For severe stage III lesions and proliferative diabetic retinopathy, total retinal photocoagulation is an effective method to reduce vision loss and blindness. The principle of total retinal photocoagulation can be simply summarized as the loss of a pawn to save a chariot. Because the retina is in a state of ischemia in diabetes, the laser can cause scarring of the peripheral retina, a decrease in oxygen consumption throughout the retina, and a significant reduction in the likelihood of neovascularization, thus protecting the macula. Laser treatment is performed with the pupil sufficiently dilated prior to laser treatment, and can be performed under surface anesthesia, usually without much pain.
Many diabetic patients have concerns about laser treatment because intraocular hemorrhage does occur in some patients after laser treatment. There are two main reasons for this: first, the patient has a heavy lesion and may bleed with or without laser, and the bleeding is coincidental, and second, the laser itself can have a certain reaction that may cause the patient’s condition to temporarily worsen.
When the patient is sicker, retinal condensation can be performed, which can lead to stabilization.
Surgical treatment
For proliferative diabetic retinopathy, vitreous surgery should be considered if there is recurrent vitreous hemorrhage or persistent non-absorption or pulling retinal detachment. The goal of surgery is to remove the accumulated blood and neovascular membrane and allow the retina to adhere back to the wall of the eye, either with laser or condensation, and the retinal lesion to stabilize. Vitrectomy is one of the more complex surgeries in ophthalmology. It is usually performed under local anesthesia, but can also be performed under general anesthesia if the patient is not cooperating well or is particularly nervous. The surgeon makes three holes in the patient’s eye, about 0.9 mm in diameter, through which the surgeon performs the intraocular surgery. Before the end of the operation, if the patient’s fundus is in good condition, the wound is closed directly and the patient does not need special positions after the operation. If the patient’s fundus is worse, the surgeon fills the patient’s eye with temporary material to allow the retina a period of time to recover. This requires the patient to remain in a special position, usually head down, for 2 weeks to several months after surgery. After vitrectomy, the retinal condition of most patients can be stabilized and some vision can be maintained, thus avoiding many previous cases of blindness as a result.
In summary: Diabetes has a significant impact on the eyes, and the number of people who go blind due to diabetic eye disease is 25 times higher than non-diabetics. Diabetes is a systemic metabolic disease that causes lesions in all parts of the eye, the most common of which, and the one that affects vision the most, is retinopathy. Diabetic eye disease is highly related to the course of the disease, and international diabetic research data confirms that retinopathy accounts for 50% of cases after 8 years of diabetes.
The pathological basis of diabetic retinopathy is microangiopathy. Our ophthalmologists divide diabetic retinopathy into two types: background type and proliferative type, and each type is divided into three stages. From stage I to stage III, the rate of development is generally slow, and the patient may be asymptomatic, and the vision is not affected. After stage IV, it is easy to cause intraocular hemorrhage and other serious complications, vision loss, and even blindness. At this time, even if the blood sugar is controlled and the systemic state improves, the pathological process of the eye cannot be reversed and local treatment is necessary to stabilize the lesion.
Prevention is the most important aspect of diabetic retinopathy. From the beginning of diabetes, the fundus should be checked regularly, at least once a year, in order to detect and treat the lesions early. Treatment means include.
Strict control of blood sugar, which can prevent further damage to the blood vessels in the fundus.
Control of blood pressure. High blood pressure can aggravate fundus vasculopathy and has the potential to significantly increase the likelihood of fundus hemorrhage. Patients must keep their blood pressure under 130/85 mmHg.
Medication: Anti-platelet coagulation drugs such as aspirin and pentoxifylline are used. In case of fundus hemorrhage, use Enola blood, Rutin, Antoiodine, etc. Chinese herbal medicine can also be used to benefit qi and nourish yin and activate blood circulation to treat the hemorrhage.
Laser treatment for proliferative retinopathy. Laser treatment is used when appropriate to protect the patient’s vision.
Surgical treatment, when intraocular vitreous hemorrhage and retinal detachment with retraction, vitrectomy is feasible to remove intraocular blood accumulation and release and reset the retina with retraction.