Determination of Retino-Choroidal Ocular Complications in Diabetes

Abstract

Diabetes mellitus (DM) is a metabolic disease with progressive evolution, present at any age, which may be accompanied by systemic complications. Retino-choroidal changes that cause Diabetic Retinopathy (DR) represent the most serious ocular complication of DM and a major cause of vision loss. DR is initially manifested through edematous capillary disease and it is followed by ischemic capilaropathy, with an onset of neovascularization by vasoproliferative angiogenic factor. The severity of DR is due to clinically significant macular edema that may be present at any DR stage, this being the most common cause of vision loss in DM. DR occurs after more than 15 years of DM evolution, timespan which allows prevention, early detection and appropriate treatment of DR by periodic rigorous monitoring of the diabetic patient, by clinical control, FO, AFG, OCT. DR prophylactic treatment requires maintaining a glycemic level as close as possible to normal, by regular monitoring of the DM and DR patient according to the type of DM, disease progression and existence of macular edema. DR curative treatment is complex and it includes: - Anti-diabetic medications, oral and injectable; - AntiVEGF agents (vascular, endothelial, growth factor) are indicated in the treatment of macular edema and therapeutic adjuvant in LP laser to block angiogenesis by inhibiting VEGF; - Laser photocoagulation (LP) is indicated in the phase of pre-proliferative, neovases, duration of diabetes, DR stage, presence of diabetic macular edema; non-continuous Pascal multispot LP laser with short pulse duration, with minimal side effects is much better tolerated by the patient than the conventional LP. Non-proliferative DR treatment is limited to the treatment of macular edema by direct focal LP and macular grid LP. Laser for macular lesions reduces the risk of vision loss of DR eyes. Proliferative DR treatment is the Panretinal Photocoagulation (PRP) (which brings greater benefits in type 2 DM); when necessary, laser photocoagulation is combined with anti-VEGF treatment in order to reduce macular edema. - Surgical treatment – vitrectomy addresses DR complications and it is recommended in: in-vitro haemorrhage, retinal traction detachment (RTD). In conclusion, DR is a serious DM complication – the patient must be monitored carefully, and the prolonged and difficult treatment must be indicated in a judicious manner and carried out with serious attention; many patients come late when eye complications and sometimes signs of low vision or vision loss are already present.