Diabetic Retinopathy – Risk Factors, Pathogenesis, Diagnosis And Treatment

Abstract: Diabetic retinopathy (DR) or diabetic eye disease, is the major long-term complication of diabetes and main cause of vision impairment and vision loss. Major risk factors of the disease are the diabetes duration and glycemia (hyperglycemia and glycemic variations). One can also distinguish high blood-pressure, lipid disorders, pregnancy and puberty, age at diagnosis, ethnicity and genetic disorders among others. Diabetic retinopathy develops as a consequence of long-term accumulation of damage of retinal vessels. Its most advanced, proliferative stage leads to complications that are a direct cause of vision impairment or vision loss. The mechanism of this pathology includes macular oedema, vitreous hemorrhage, neovascular glaucoma and tractional retinal detachment by fibrovascular proliferations. Diabetic eye disease remains asymptomatic at the primary stages. In more advanced phases gradual vision acuity impairment is reported. In some cases, type 2 diabetes is diagnosed at the same moment as diabetic eye disease, which threatening with blindness. Running screening tests (fundus photography) allow to detect early, asymptomatic disease’s stages. Most frequently used diagnostics method to recognize DR ad hoc is direct ophthalmoscopy. Other useful methods are optical coherence tomography (OCT) and fluorescent angiography among others. Regular routine tests play a crucial role in DR diagnose. Pregnant women should be treated with special attention. The most substantial form of treatment and/or prevent from progress is intensification of metabolic control, minimalization of glucose fluctuations and achieve the normoglycemia. Laser coagulation and vitrectomy are also recommended, bearing in mind that their early performance gives better results. Intravitreal application of vascular endothelial growth factor (VEGF) antagonists and steroids has a positive impact on macular oedema.

Authors:

Teresa Wolniewicz, Michal Proczka, Adam Trzcinski, Anna Ramotowska

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