1.What are the main manifestations and dangers of diabetic retinopathy? Diabetic retinopathy is a serious complication of diabetes and has become one of the major blindness-causing eye diseases. Its occurrence is closely related to the duration of diabetes and blood glucose control, and its incidence increases gradually with the duration of the disease. Long-term hyperglycemia leads to damage to the microvasculature of the retina. Early on, the permeability of the blood vessels increases, and fluid or other components within the vessels leak into the retina, resulting in microaneurysms, hemorrhages, hard or soft exudates, dilated retinal veins, and mild to moderate loss of vision, clinically known as simple type; due to long-term ischemia and hypoxia of the retina, after a period of time, some small neovascularization grows on the retina, known as proliferative type. These abnormal blood vessels are very easy to rupture and bleed, and more bleeding will seriously affect vision. Repeated bleeding can also lead to the formation of vitreoretinal mechanized film, causing secondary retinal detachment, and even complicate neovascular glaucoma, leading to blindness and eye atrophy. 2.How to detect diabetic retinopathy at an early stage? Early detection is the key to timely and proactive treatment. All diabetic patients should undergo fundus examination every 3-12 months according to the course of diabetes and the examination by ophthalmologist, and the interval between examinations should be shortened in severe cases. If the examination reveals retinal abnormalities, a fundus fluorescence angiogram is usually ordered. This examination is extremely valuable in understanding the extent of diabetic retinopathy, selecting treatment options, guiding photocoagulation therapy, and objectively judging the efficacy of treatment, and some patients require a repeat angiogram about six months to a year. Depending on the situation, visual electrophysiology, visual field, OCT and other examinations can also be performed. 3.How is diabetic retinopathy treated? The fundamental treatment is strict medical treatment, including dietary treatment, oral hypoglycemic drugs, insulin and Chinese herbal medicine, as well as auxiliary use of blood-boosting drugs and vitamins, etc. Strict blood sugar control at an early stage can significantly delay its occurrence. It is very important to determine the severity of retinal lesions imminent or neovascularization has occurred through fundus angiography, and timely retinal photocoagulation treatment. In the absence of a complete cure and prevention of diabetic retinopathy, photocoagulation therapy has proven to be the only effective way to prevent blindness in diabetic retinopathy and has become the mainstay of treatment and prevention of blindness in diabetic retinopathy. For patients with severe vitreous hemorrhage and retinal proliferation, traction and detachment, only vitrectomy treatment can restore partial vision. Pre-operative intravitreal injection of anti-VEGF drugs can reduce bleeding during surgery and better recovery of vision after surgery, but the disadvantage is that it is expensive. 4.What is the mechanism of photocoagulation therapy for diabetic retinopathy? The possible mechanisms of photocoagulation are: eliminating neovascularization, reducing retinal edema and occluding abnormal leaking and bleeding vessels; destroying some cells with high metabolism and high oxygen consumption, improving the hypoxic state of the retina and helping to ensure the blood and oxygen supply to the macula in important parts; the scar formed by photocoagulation can resist the pulling on the retina and prevent retinal detachment. 5.What are the methods of photocoagulation for diabetic retinopathy? Depending on the severity of the disease as determined by fundus examination and imaging results, standard whole retinal photocoagulation, macula grid-like photocoagulation, and local photocoagulation can be used, usually done in 3-5 sessions, each at an interval of 1-2 weeks. Some patients need additional photocoagulation treatment after a period of time after completing laser treatment, if necessary after examination. 6.What are the precautions before performing photocoagulation treatment? First of all, recent fundus fluorescence angiography results should be available to help the doctor clarify the location and severity of retinal neovascularization in order to guide accurate treatment. Having refractive interstitial unclearness, such as having corneal clouding, cataracts, or vitreous fundus hemorrhage with more obstruction of light passage, are not conducive to photocoagulation treatment, and some patients need to have their cataracts removed first. Proliferative diabetic retinopathy, if left untreated, often leads to blindness within a relatively short period of time due to hemorrhage and retinal detachment. Photocoagulation does not completely stop its development, but only greatly reduces the chance and extent of hemorrhage and lowers the proportion of severe vision loss, and all patients who undergo photocoagulation should have a clear understanding of this, and there are even a few severe patients who have hemorrhage while waiting for laser treatment and are forced to Surgery. 7.What should I pay attention to during photocoagulation treatment? Patients who have been examined and determined to undergo retinal photocoagulation should register for an appointment at the ophthalmic surgery room on the third floor of the outpatient clinic with the laser treatment charge slip, bring the imaging results and medical records to the laser room at the designated time, and wait for the staff to administer the drug. During the treatment, keep your mind calm, don’t be nervous, try to keep your head position still so as not to affect the accurate targeting of the laser treatment, and keep the other eye closed to avoid damage caused by laser scattering. The treatment may have a slight soreness and pain, can not tolerate or other special circumstances in time to explain to the doctor, the doctor will be properly adjusted, do not suddenly move the head position significantly to prevent the laser caused by other places of injury. 8.What are the possible complications after photocoagulation therapy? In advanced diabetic retinopathy, it is difficult to restore ideal visual function regardless of the treatment method. Although photocoagulation therapy has some negative impact on visual function, it is very effective in saving and maintaining the useful vision of patients, and the risk of this treatment is very low. Photocoagulation therapy can reduce the risk of severe blindness in approximately more than 60% of progressed diabetic retinopathy, but it cannot avoid All hemorrhages and vision loss can be avoided. The incidence of complications of retinal photocoagulation is low, but very few patients may experience early temporary loss of vision (which takes about six months to recover and remain stable), corneal epithelial erosion, increased clouding of the lens, transient elevation of intraocular pressure, uveitis, increased macular edema, exudative retinal detachment, ruptured hemorrhage from neovascularization of the retina, and changes in visual field, which occur with the patient’s disease itself still progressing The occurrence of these cases is related to the condition of the patient’s disease, the degree of cooperation in the treatment process, the side effects of the laser itself and other factors, which generally do not cause serious consequences. 9.Why do I need to review after photocoagulation treatment and how to follow up? The success of photocoagulation therapy for diabetic retinopathy needs to be combined with blood glucose control and other adjuvant medications, and should be confirmed and adjusted during continuous observation. Generally, the activity of neovascularization should be reassessed 2-3 months after total retinal photocoagulation. If the neovascularization has atrophied and the photocoagulated pigment spots are evenly distributed, the patient can be followed up after 3 months, and fundus angiography done 2-3 months after total retinal photocoagulation reveals that if there is still neovascular growth, additional photocoagulation therapy is needed. Long-term studies have shown that those patients with better visual acuity are closely associated with their active follow-up. In conclusion, diabetic retinopathy is a complex and diverse condition with a poor prognosis for advanced visual acuity. Laser therapy is the primary treatment for diabetic retinopathy and proactive laser therapy is the key to saving patients’ visual function and improving their quality of life. Remember: early laser prophylaxis is simpler, more economical and more effective than any complex surgical treatment at a later stage.