The treatment is not only ophthalmological but must be systemic as well. The best results when trying to slow the progression of the disease are obtained when the opthalmological treatment is combined with a good glycemic control. The treatment includes panretinal photocoagulation with laser, intravitreal injections of antiangiogenics and vitrectomy surgery, according to the severity of each case
Laser surgery
The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema, proliferative diabetic retinopathy and neovascular glaucoma. Laser surgery is usually performed in an office setting under topical anesthesia (eyedrops).
With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. Usually the vision improves although the finality of the treatment is to prevent worsening of the edema.
In proliferative retinopathy PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This 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. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment.
Vitrectomy surgery
Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is often performed on an outpatient basis or with a short hospital stay. Either a local or general anesthetic may be used.
During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again.
Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.
To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist's instructions so your eye will heal properly.
Medication injections
In some cases, medication may be used to help treat diabetic retinopathy. Sometimes a steroid medication is used. In other cases, you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.
After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve how well you see.
Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.Read more.
Retinal Tears
Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office.
Laser surgery (photocoagulation)
With laser surgery, a laser is used to make small burns around the retinal tear. The scarring that results seals the retina to the underlying tissue, helping to prevent a retinal detachment.
Freezing treatment (cryopexy)
Your eye surgeon uses a special freezing probe to apply intense cold and freeze the retina around the retinal tear. The result is a scar that helps secure the retina to the eye wall.
Retinal detachment surgery Scleral buckle
This treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place. The ophthalmologist often drains the fluid under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room.
Pneumatic retinopexy
In this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done in the ophthalmologist’s office. Your ophthalmologist will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear.
Vitrectomy
This surgery is commonly used to fix a retinal detachment and is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble. Sometimes an oil bubble is used (instead of a gas bubble) to keep the retina in place. Your body’s own fluids will gradually replace a gas bubble. Sometimes vitrectomy is combined with a scleral buckle. If a gas bubble was placed in your eye, your ophthalmologist may recommend that you keep your head in special positions for a time. Do not fly in an airplane or travel at high altitudes until you are told the gas bubble is gone.Read more.
