Diabetic ophthalmopathy (eye damage in diabetes mellitus)

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Diabetic ophthalmopathy (eye damage in diabetes mellitus)

Diabetic ophthalmopathy is a non-inflammatory pathological process of the eyes, which is a secondary manifestation of the underlying disease – diabetes mellitus, and is caused by a violation of carbohydrate metabolism in the body. 

The occurrence of diabetic ophthalmopathy is associated with general physiological, biochemical and immune disorders, one of which is a change in the properties of blood and blood vessel walls. At the same time, eye tissues in diabetes mellitus are in a state of chronic oxygen starvation, which leads to damage to the retina of the eye – diabetic retinopathy. It accounts for about 70% of all cases of diabetic ophthalmopathy. The remaining third of cases of diabetic ophthalmopathy manifests itself in the form of diabetic cataract (clouding of the lens), secondary rubeous glaucoma, chronic blepharitis, cholazion, barley, and transient decrease in visual acuity.

Diabetic retinopathy as one of the most common complications of diabetes mellitus

In diabetes type 1 diabetic retinopathy (retinal disease) is more common than in diabetes mellitus type 2, and over time results in a significant impairment of vision or blindness. Being a microvascular complication of diabetes mellitus, diabetic retinopathy is characterized by changes in the retina, active growth of newly formed vessels, and pathological processes in the macular region (macula).  

According to the World Health Organization, a number of stages are distinguished in the clinical course of diabetic retinopathy:

1. Non-proliferative stage . At this stage, during an ophthalmological examination of the eyes, microaneurysms can be detected, which are capillary walls protruding in the form of sacs, dilatation of the ophthalmic veins and the formation of venous loops. During this period, with preserved central and peripheral vision, a reduced level of color perception, a decrease in contrast sensitivity, and a low level of adaptation to darkness are objectively revealed. 

2. The preproliferative stage . Changes in the fundus and retina at this stage are more pronounced. Small hemorrhages, soft and dense exudates, swelling of the corpus luteum area appear on the retina. This stage is characterized by anomalies of the veins and capillaries of the retina. Some areas of the retina are completely deprived of blood supply due to blockage of small vessels by blood clots. Due to the involvement of the corpus luteum in the process, a decrease in visual acuity is noted at this stage. 

3. Proliferative stage . Many new fragile vessels appear on the retina, the optic nerve head, which bursting form new hemorrhages that affect the vitreous body. At the site of the hemorrhage, connective tissue grows, which over time leads to retinal detachment and ruptures, as a result of which the patient may go blind. 

Optic nerve changes in diabetic ophthalmopathy

Diabetic ophthalmopathy can manifest itself in the following types of pathological changes in the optic nerve:

– atrophy of the optic nerves , which is a concomitant pathology of juvenile diabetes. This pathology is characterized by a progressive decrease in vision, narrowing of the visual field and blanching of the optic discs; 

– papillopathy , which occurs in a state of decompensation of the underlying disease and is characterized by sharp bouts of blurred vision, edema of the optic nerve head and corpus luteum. 

– anterior and posterior neuropathy of ischemic genesis . This pathology is characterized by such signs as a sharp one-sided decrease in visual acuity, sector loss in the field of view. The outcome of this process is most often partial or complete atrophy of the optic nerve. 

Signs and complications detected in patients with diabetic ophthalmopathy

Diabetes mellitus is accompanied by impaired microcirculation of the conjunctiva of the eye. When examining the conjunctiva of the eye with a slit lamp in patients with diabetic ophthalmopathy, there is an increase in the tortuosity of venules, expansion of capillaries in the form of aneurysms, destruction of capillaries and their clogging with blood clots.

A characteristic sign of diabetic ophthalmopathy in the study of the iris is sclerosis of the vessels of the iris, neovascularization, i.e. the formation of new vessels, called rubeosis. In this case, the iris loses its elasticity and mobility, which worsens the possibility of its expansion with the help of drugs. Due to rubeosis and the proliferation of connective tissue at the site of hemorrhages, the outflow of intraocular fluid is disturbed, which leads to an increase in intraocular pressure and the development of secondary diabetic glaucoma . Most often, rubeous glaucoma in patients with diabetes mellitus is combined with cataracts, retinal detachment and intraocular hemorrhage. 

Patients with diabetes mellitus, due to a decrease in local and general immunity, are more susceptible to the influence of stress factors and pathogens of infectious diseases. that is why diabetic ophthalmopathy often manifests itself in the form of inflammation of the conjunctiva, blepharitis, erosive lesions of the cornea. Pathological processes do not bypass the lens, the volume of which increases, which leads to a decrease in the depth of the anterior chamber and the development of diabetic cataract . In addition, due to metabolic disorders, a weakening of the capsular-ligamentous apparatus of the lens is observed, which increases the risk of its subluxation. 

Principles and methods of treatment for diabetic ophthalmopathy

Since diabetic ophthalmopathy is a concomitant pathology of diabetes mellitus, its development and progression are primarily associated with the level of glucose in the blood, as well as the state of diabetes compensation. Therefore, before embarking on symptomatic treatment of ophthalmopathy, it is necessary to achieve optimal compensation for the level of glucose in the blood, and to normalize the indicators of water-salt, protein and fat metabolism.

At the initial stages of development of diabetic ophthalmopathy, they resort to conservative treatment, which involves drawing up a clear plan for taking medications for therapeutic and prophylactic purposes. The treatment regimen may include drugs that affect thrombus formation, antioxidants, antiplatelet agents, immunocorrective and enzymatic, as well as steroid and non-steroidal anti-inflammatory drugs. If, despite symptomatic drug treatment and correction of the underlying disease, there is a progression of signs of the pathological process, then they resort to surgical intervention.

Currently, one of the main and effective surgical methods for treating diabetic retinopathy is laser coagulation of the retina. In addition, advanced technologies of microsurgical intervention on the vitreous body are being actively developed and introduced into practice.

In the proliferative stage of diabetic retinopathy, the use of vitrectomy is effective. The indications for its implementation are long-term or extensive hemorrhages in the eye, as well as retinal detachment. Modern methods of vitrectomy involve the use of silicone, perfluorine compounds, implantation of collagen membranes of artificial origin, which significantly increases the likelihood of a favorable outcome of surgery even in advanced cases.

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