Non-Proliferating Diabetic Retinopathy

PATHOLOGY

The DME can cause very serious damage to the macular area, the region of the retina that is responsible for the central vision, and is the main cause of legal blindness in working age people.

The DME is due to the alteration of the capillary permeability caused by a high concentration of blood glucose (hyperglycemia) that is often to be found in diabetic patients. At the retinal level, in fact, hyperglycemia extended over time determines conditions of retinal hypoxia that has for its consequence an excessive production of molecules referred to as growth factors, among which the  vascular endothelium growth factor (VEGF) is vested with particular importance; it promotes the growth and permeability of the blood vessels.

In patients suffering from DME an excessive permeability of the retinal blood vessels occurs, with exudation and accumulation of fluids under the retina and consequent formation of macular edema, retinal ischemia, micro aneurysms and retinal hemorrhages.

DIAGNOSIS
Diabetic retinopathy is able to damage the vision in a very serious and irreversible manner. The main symptoms of this pathology are: blurring of the central vision, difficulty in perceiving colors and sometimes reduction of the vision at night.  The treatments available today are effective in general in safeguarding the sight of the patients, but unfortunately they are not final, since the patients often need a periodic re-treatment.  The most effective remedy against this dangerous eye pathology remains prevention, which is obtained principally through a close control of the sugar level in the blood and an early diagnosis, which is obtained thanks to a careful regular monitoring of the retina through tests such as the high resolution Optical Coherence Tomography (OCT)  for examining each individual retinal layer and identify the presence of a cystoid macular edema (CME) and the Fluoroscein Angiography (FAG) and the Indocianine Green Angiography (ICGA). Such tests are very little invasive and are executed by means of two contrast agents, necessary for identifying the ischemic areas in the peripheral retina and any associated neovascular membranes.  These tests make it possible to early diagnose the diabetic retinopathy and, if necessary, to promptly intervene with the most adequate treatment before very serious damage to the vision occurs.

Diabetic patients should follow a prevention protocol associated to a regular monitoring of the retina possibly within the first year after the diabetes diagnosis. Diabetic women during pregnancy must submit to particularly intensive controls, starting already from the first quarter, since diabetic retinopathy can advance very rapidly during pregnancy.

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TRATTAMENTO

The treatment more commonly used for fighting DME is the ablation of the peripheral ischemic retinal areas that produce VEGF by means of panretinal photocoagulation laser (PRP). This procedure contributes to avoiding a further reduction of the vision, but not to the recovery of the lost visual functionality.

The understanding of cellular and molecular mechanisms that are at the base of the onset of the diabetic macular edema has permitted the research of new alternative therapies, above all of a pharmacologic type, opening very promising paths for the treatment of DME, such as in the case of  slow  release intravitreal steroid implants.

The individuals suffering from diabetes mellitus must pay particular attention to the prevention of this terrible pathology through a scrupulous control of blood risk factors, in particular blood glucose, but also high blood pressure and hyperlipidemia. This permits to avoid or at least delay as much as possible the arising of serious complications deriving from diabetic retinopathy.

WE CAN HELP YOU

If you believe that you are suffering from this pathology or you have any doubts that you wish to be clarified you can contact us.

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