Basics of Diabetic Retinopathy Treatment
In the beginning stages of diabetic retinopathy, there may be no treatment needed. Diabetics should be diligent about controlling their blood glucose by maintaining a proper diet, exercise, control blood pressure, maintain good cholesterol levels, and properly taking their medications. This is the major way that diabetics can reduce their risks of complications from diabetes. There are a variety of different treatments for the different stages of diabetic retinopathy.
Laser Photocoagulation of the Retina
Focal Laser Treatment
Laser treatment is used for the treatment of macular edema. The macula swells due to the leaking vessels in the macular area. A fluorescein angiogram will be done to see where the leaking is located. Laser treatment is then applied to those areas to stop the leaking process.
Panretinal Laser Treatment
Panretinal Photocoagulation (PRP) is indicated for the treatment of proliferative diabetic retinopathy. The treatment consists of applying laser burns to the retina in a scattered pattern throughout the entire retina except for the macular area. There will be 1,500 to 2,200 laser spots applied to the retina. This is usually done in two or three settings.
In proliferative diabetic retinopathy the retina is ischemic and releases a substance that stimulates new fragile vessels to grow into and on the retina. These vessels bleed easily and also have fibrous tissue that can grow along with the vessels. These strands can cause traction retinal detachments.
The laser treatment actually destroys part of the retina and this decreases the release of the vascular growth substance. The patient will lose some of their side and night vision. This is better than losing all or a significant portion of their vision.
Intravitreal Triamcinolone Steroid Injection
Intravitreal Triamcinolone steroid injections may be used in many cases of maculae edema. The injection is placed inside the back portion of the eye into the vitreous. The corticosteroid lasts for up to three months and may have to be injected again. The side effects of the injections are glaucoma, cataracts, hemorrhage, and possible infection (endophthalmitis).
Intravitreal Anti-VEGF Injections
Intravitreal Anti-VEGF injections have been used recently for patients with macular edema. It may be combined with laser treatment as well. It requires monthly injections until the edema resolves.
Vitrectomy is indicated in patients with vitreous hemorrhages, cloudy vitrous, and traction retinal detachments. Vitrectomy surgery is an operation in which tiny instruments are placed through the sclera (white portion of the eye) into the posterior chamber of the eye. The blood and/or cloudy vitreous are removed. If a traction retinal detachment is present the instruments can be used to release the traction. Laser photocoagulation can also be applied during the vitrectomy.