A Answers (5)
If nonproliferative retinopathy has led to macular edema (swelling of the retina), laser photocoagulation, a type of surgery that uses an intense beam of light, is used to burn and seal the leaking blood vessels and decrease tissue swelling, thereby decreasing the likelihood of further vision deterioration.
For proliferative retinopathy, laser surgery known as panretinal photocoagulation, which uses a scattered laser, is used to stop the growth of new blood vessels, thereby decreasing the likelihood of serious side effects including vitreous hemorrhage and retinal detachment.
Vitrectomy is a surgical treatment that can help restore vision by removing a vitreous hemorrhage or repairing retinal detachment.
Several new treatments are also being evaluated to determine if they curb progression of retinopathy or decrease vision loss associated with it. These treatments include oral medications for nonproliferative disease and intraocular injections of anti-inflammatory medications (steroids) for macular edema.
During the first three stages of diabetic retinopathy, no treatment is needed unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol.
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions are usually required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may be possible, depending on the amount of bleeding. If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.
This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.
Diabetic retinopathy is treated based on the extent of the retinopathy in the back of the eye. Watch this video to learn more about how diabetic retinopathy is treated.
The best treatment is to prevent the development of retinopathy as much as possible. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss from diabetic retinopathy. If high blood pressure and kidney problems are present, they need to be treated.
Medical treatment. Injections of anti-VEGF medication in the eye can stop the growth of new blood vessels and subsequent bleeding. VEGF is necessary for the eye to build new blood vessels and the use of anti-VEGF medication causes regression of these fragile and abnormal blood vessels. Sometimes a steroid medication may also be used.
Laser surgery. Laser surgery is often recommended for people with macular edema, PDR and neovascular glaucoma.
For macular edema, the laser is focused on the damaged retina near the macula to decrease the fluid leakage. The main goal of treatment is to prevent further loss of vision. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement. A few people may see the laser spots near the center of their vision following treatment. The spots usually fade with time but may not disappear.
For PDR, the laser is focused on all parts of the retina except the macula. This panretinal photocoagulation treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur.
Multiple laser treatments over time are sometimes necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.
Vitrectomy. In advanced PDR, your ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, which is performed in the operating room, the blood-filled vitreous is removed and replaced with a clear solution. Your ophthalmologist may wait for several months to see if the blood clears on its own before performing a vitrectomy.
Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused the bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should usually be done early because macular distortion or traction retinal detachment will cause permanent visual loss. The longer the macula is distorted or out of place, the more serious the vision loss will be.
: If retinopathy of prematurity does not improve, patients may undergo a procedure called cryotherapy. This procedure helps stop the growth of abnormal blood vessels. During the procedure, an instrument, called a cryoprobe, is placed on the outside of the eye. This instrument freezes the abnormal blood vessels growing inside the eye. As a result, the blood vessels stop growing and shrink. The patient does not feel any pain because the eye is numbed. Photocoagulation
: If retinopathy of prematurity does not improve, patients may undergo laser photocoagulation to remove abnormal retinal blood vessels. During the procedure, a laser is directed at the area of abnormal blood vessel growth. This destroys abnormal blood vessels. Vitrectomy
: In patients with diabetic retinopathy, abnormal blood vessels may leak blood into the vitreous. If this condition does not resolve on its own, it may be treated with a procedure called vitrectomy. The eye surgeon uses delicate instruments to remove the blood-filled vitreous. In addition to removing the vitreous fluid, scar tissue that is pulling on the retina is also removed. This helps reduce the risk of a retinal detachment and prevent the loss of vision. The removed tissue is then replaced with a salt solution (saline) in order to maintain the normal pressure and shape of the eye. Once the vitreous blood is removed, vision is restored. Pneumatic retinopexy
: A pneumatic retinopexy may also be performed to treat a detached retina. This technique is usually performed when the tear is located in the upper part of the retina. First, the tear is treated with cryotherapy or laser therapy. Then, a bubble of expandable gas is injected into to the eye cavity. The gas bubble expands over the next few days, pushing the retina to help it reattach to the wall of the eye. Control blood sugar
: Patients with diabetic retinopathy should closely monitor their blood sugar levels. Controlling blood sugar levels with medications and proper diet helps prevent the condition from developing or worsening.
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