NIO - National Institute of Ophthalmology



	DIABETIC RETINOPHATHY

	Diabetic retinopathy is the commonest cause of blindness in the population of working age, in the devoloped nations and is of incresing importance in the devoloping nations like India which has the largest number of diabetic patients in the world. How to see...
		Light enters the eye through the Pupil. The light passes through the clear tissue of the lens and the vitreous (the clear gel that fills the eye). The light then strikes the retina, where special cells send signal to the brain. The brain turns these signals into visual images what you see.

	The Healthy Retina
	A healthy retina includes the macula, the area of the retina where the sharp central vision takes place. The fovea,the most sensitive part of the macula The periphery, which surrounds the macula, provides peripheral (side) vision - what we see outside our sharp central vision. Capillaries that nourish the retina with blood

	What is diabetic retinopathy?
		As a general statement, the prevalence of Diabetic Retinopathy (DR) of any severity in the diabetic population as a whole, is approximately 30% In diabetes, the blood vessel of the retina become leaky andtherefore the blood spots are seen on the retinal surface.
	This stage retinopathy is called non proliferative stage. This is the early stage of diabetic retinopathy and needs no treatment. However, adequate control of blood sugar levels and regular retinal evaluation is mandatory. But if it progresses then laser treatment is needed to prevent further deterioration.

	This stage retinopathy is called non proliferative stage. This is the early stage of diabetic retinopathy and needs no treatment. However, adequate control of blood sugar levels and regular retinal evaluation is mandatory. But if it progresses then laser treatment is needed to prevent further deterioration.

	In case the retinopathy progresses even further abnormal retinal blood vessels start proliferating on the retinal surface. This is called as proliferative stage of the retinopathy and needs prompt treatment. The abnormal blood vessels leak fluid and blood, leading to severe bleeding inside the eye called vitreous hemorrhage. needs prompt treatment.

	Diabetic Maculopathy
	In some patients, the leakage from the retinal capillaries or obstruction of the capillaries affects the central retina called as macula and it leads to swelling of macular area causing reduction of vision Who can get diabetic retinopathy ? Longer duration of diabetes Poor control of blood sugar levels Pregnant women Patients having hypertension Patients with kidney disorder Smoking Obesity Increased cholesterol levels Treatment options :
	Fluorescein Angiography :
	In case the retinopathy is severe, the ophthalmologist may decide to do this diagnostic test in which a dye is injected in the arm vein and retinal photographs are taken at regular intervals. This gives an idea of amount of leakage and the location of amount of leakage and the location of the abnormal retinal blood vessels. During the procedure, you may briefly feel some nausea. After the procedure, your skin, eyes and urine may appear yellow for a few hour.

	What's the next step?
	your pathologist will work with you to design a treatment plan that's best for you. You may need more than one type of treatment. Laser photocoagulation - To control the leaking capillaries and prevent the growth of new capillaries. Anti VEGF injection - to stop the leakage from the abnormal blood vessels. Triamcinolone injection - to reduce the swelling in the macular area. Vitrectomy - to remove a cloudy vitreous and scar tissue. Cryotherapy - to shrink capillaries and repair the retina Other surgery or medication as recommended by your ophthalmologist.

	Laser photocoagulation
	This is an OPD procedure in which a laser beam (commonly 532nm wavelength) is used to stop the growth of abnormal vessels and the leakage from the blood vessels. The aim of the treatment is to prevent the further loss of vision and to preserve the existing vision. the laser treatment is not aimed at improving the vision. The laser treatment is often completed in 3 to 5 session depending on the severity of the retinopathy. Bring dark sunglasses to wear, on the way home. Arrange for someone to drive you home after the procedure. This treatment dosen't cure diabetic retinopathy. But it may slow or halt the progress of the disease. Regular follow up is must.

	Anti VEGF treatment
	This is new modality of treatment. In patients who fail to show adequate response inspite of the laser treatment or those patients who already have very severe retinopathy, an injection of Anti VEGF drug is given inside the eye, to arrest the growth abnormal blood vessels. the procedure is done in the operating room and an eye pad is given for 3-4 hours. You will be required to stay in the hospital for atleast half an hour after the injection. some patients require repeat injection.

	Intravitreal triamcinolone injection :
	In patients with severe macula edema, an injection of triamcinolone - a depot steroid is given to stop or reduce the swelling of the macula.

	The procedure is done in the operating room and an eye pad is given for 3 - 4 hours. You will be required to stay in the hospital for atleast half an hour after after the injection. some patients require repeat injections.

	Vitreo retinal surgery :
	Preparing for vitrectomy
	Before your surgery, tell your doctor about medications, herbal remedies, or supplements you use. These may include aspirin, ibuprofen, blood thinners etc. Vitreo retinal surgery In patients with non resolving vitreous hemorrhage or retinal detachment a complex surgery is performed. In this surgery the blood or debris is removed and an attempt is made to reattach the retina. The laser is then performed. If needed, the surgeon can choose to put silicon oil or gas inside the eye, to provide tamponade to the retinal surface. The surgery may last for several hours. some patients need another operation, if the retina does not get attached with the first surgery.
	After Vitrectomy
	You will be told how to care of your patch or bondage. You will be also instructed to maintain a particular position while sleeping. Do not rub, bump, or touch your eye. You will receive medication to control pain. Generally, patients are required to stay at the hospital for a day or two.
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