According to statistics, 7% of those with a 10-year history of diabetes have retinopathy, about 25% of those with 15 years, and the incidence of 20-year type 2 diabetes is 60% for those taking oral hypoglycemic drugs and 84% for those injecting insulin. Diabetes mellitus is a multisystem disease with a predominantly glucose metabolism disorder, which easily leads to metabolic disorders of retinal tissue, resulting in abnormal retinal vascular function and structure.
The main symptoms of pure diabetic retinopathy
(1) Microangioma: It is the earliest and more precise clinical sign. They are located in the inner retinal nucleus layer, small dots, often appearing first in the posterior pole of the fundus, especially in the macula, and mostly distributed in the temporal side.
(2) Intraretinal hemorrhage: located at the end of the capillary vein, deep in the retina, in the shape of a round spot or flame.
(3) Sclerotic exudate: located in the inner retina between the plexiform layer and the inner nuclear layer. It appears as waxy yellow dots and flakes with relatively clear borders. It is most common in the posterior pole. The center of the hard exudate ring contains microaneurysms. When the macula is involved, large stellate spots may appear. Hard exudate of macula is also the cause of severe visual impairment.
(4) Retinal edema: Initially, the edema is located between the outer plexiform layer and the inner nuclear layer, further involving the inner plexiform layer and the nerve fiber layer, and finally reaching the whole retina. Clinically, the retina is swollen and thickened with an opaque appearance, and the macular edema is cystic in appearance, which can be clearly shown by fluorescence angiography.
Proliferative diabetic retinopathy symptoms
This type is characterized by the appearance of neovascularization and proliferative lesions on top of simple diabetic retinopathy. The fragile neovascularization predisposes to recurrent hemorrhage with proliferation of retinal fibrous tissue.
Neovascularization begins with vascular endothelial cell buds that may extend through the inner border membrane to the retinal surface. Fibrous proliferation of preoptic disc neovascularization, usually fan-shaped or radially elongated, often adheres to the back of the vitreous or even protrudes into the vitreous, which can lead to vitreous hemorrhage and detachment of the retina by traction
Principles of screening
The early clinical symptoms of diabetic eye disease are not obvious and easily missed, and the late treatment is very tricky and ineffective. Screening for diabetic eye disease can be of great value for early detection of diabetic patients. Screening for diabetic eye disease should pay attention to the following points.
1. All children and adolescents with type 1 diabetes should be screened for eye disease. If no retinopathy is found, the fundus should be examined once a year thereafter, and if retinopathy is found, the number of fundus examinations should be increased each year thereafter. Especially in the case of unsatisfactory long-term control of blood sugar or kidney disease, the number of fundus examinations should be increased.
2.Patients with gestational diabetes should have a fundus examination every 3 months or even less during pregnancy.
Type 2 diabetic patients should have their fundus examined when they are first diagnosed with diabetes because retinopathy is already present in 10 to 28% of patients who are first diagnosed with type 2 diabetes.
If retinopathy is found, the fundus retina should be examined once a year or once every six months or less.
Screening program
Detection of diabetic retinopathy should include the following items
1.Visual acuity of the naked eye
2.Cataract condition
3.Fundus condition, etc.
4.In areas where conditions are available, retinal photographic examination is performed, which has the advantage of retaining objective records permanently, and such images can be retained for a long time.
Principles of treatment for diabetic retinopathy
1.Actively control the primary disease: early diagnosis of diabetes, early treatment with controlled diet, oral hypoglycemic drugs or insulin injection, and appropriate exercise to control diabetes are important measures to prevent, delay or reduce diabetic retinopathy.
2.Laser treatment: It can directly coagulate and close neovascularization, microvascular tumors and capillaries with fluorescent leakage, stop vitreous hemorrhage and retinal edema without affecting the function of macula. Laser treatment of neovascularization
When treating neovascularization, the feeding arteries are first closed and the surrounding retina is coagulated at the same time, so that it is converted from a hypoxic state to a non-oxygenic state, thus reducing the production of neovascularization or causing it to atrophy. Supplementary laser treatment is required annually, depending on the FFA, if necessary, to close the incipient
The development of neovascularization.
Image after retinal photocoagulation
Fundus fluorescence imaging after total retinal photocoagulation
3. Conservative pharmacological treatment: Diabetic retinopathy is due to microangiopathy within the retinal microcirculation with microthrombus formation, so the following medications can be used.
Antioxidant drugs, such as vitamin E and C.
Drugs to improve microcirculation, represented by calcium hydroxybenzoate.
4, vitrectomy: In recent years, for those with proliferative diabetic retinopathy, the treatment of removing intravitreal mechanization can be used to prevent tractional retinal detachment and improve visual acuity.
Diagram of vitrectomy surgery
Self-care
For all diabetic patients, blood glucose control is the absolute first priority. At the same time, in order to detect and treat diabetic-induced eye lesions early, regardless of whether there are vision changes, they should receive regular eye examinations.
1. For those with stable blood glucose control, fundus examination should be performed once every six months.
2.If the blood sugar control is unstable, it should be checked once every three months.
For gestational diabetes, a history of internal eye surgery, or a history of fundus lesions, the interval between eye examinations should be shortened.
4. Proper dietary control, moderate exercise, reasonable medication, good blood sugar control and improved quality of life can delay the occurrence of diabetic retinopathy.
5.Ophthalmology examination should be performed when there is blurred vision, flashing light in front of the eyes, difficulty in reading, double vision, pain, black shadow in front of the eyes and visual field defects.