DIABETES – RETINA

Diabetes is the leading cause of blindness in the world...

When the pancreas does not produce enough insulin or the body does not use the insulin it produces properly, diabetes, a chronic disease, results.

The main cause of blindness and poor vision in a healthy person is precisely diabetes. Unfortunately, diabetes often damages the eye and not only that, diabetes spares no part of the eye when it occurs.

The worst possible complication in the diabetes-eye connection is diabetic retinopathy.

When diabetic retinopathy is diagnosed, it means that the inner layer of the eye, the retina, which is made up of nerve cells, has been damaged. The light that enters the eye is converted into an electrical impulse in the nerves of the retina that "travels" to the brain, and that is how we see. So, the retina plays an important role in vision in everyone, but is particularly affected in diabetes because it is precisely the "target" of a very small blood vessel.

The changes that occur at the front of the eye may look like the following:

  • stye (on the eyelids).
  • frequent inflammation, conjunctivitis (on the clutch)

- decreased sensitivity of the cornea (neurotrophic keratitis)

- neovascularization of the iris (at the iris)

- reduced ability to see in the distance

- blurred vision

- the occurrence of double vision

The first and most important step in the treatment of retinopathy is constant and detailed monitoring, even if no other visible changes occur. In addition, the controls depend on the blood sugar control, the type of therapy itself and the general changes that have occurred.

The treatment is carried out with the laser, i.e., the damaged parts of the retina are punched with the laser. If the disease is advanced, a more elaborate procedure called VITRECTOMY.

Treat eyes affected by diabetes in a timely manner because the condition can be more serious than it looks. Prevent eye barb or glaucoma from forming unnecessarily!

A retinal ablation or retinal detachment is an emergency that must be operated on as soon as possible, preferably within 24 hours. During ablation, the retina tears and a retinal hole is created. An eye guide is inserted through the retinal hole and the retina is separated from the back of the eye. The entire operation is called a vitrectomy.

Vitrectomy is usually performed on an outpatient basis under local anesthesia. The surgery can take anywhere from an hour to several hours.

During the procedure, the surgeon makes two or three holes in the sclera and uses a microscope to see inside the eye and perform the following steps or more with microsurgical instruments:

- remove the completely opacified vitreous body

- remove scar tissue from the retina

- remove all muttins

- remove all objects that should not be in the eye

- return the retina to its natural position

- repair the torn retina with a laser

- put an air or gas bubble in the eye to keep the retina in the right position (the bubble will be reabsorbed after a while)

- put silicone oil into the eye (the oil will be removed later during the second surgery)

 

Recovery

Vitrectomy procedures are often performed in conjunction with other eye surgeries, so individual recovery times and recommendations will vary.

AND activities such as driving, reading, and sports must be avoided for several years after surgery.

Uni eye drops are prescribed to prevent infection and reduce inflammation.

The recovery process takes between 4 and 6 weeks.

Diabetic retinopathy is a complication of diabetes in the eye.

If it is established that a patient is suffering from diabetic retinopathy, this means that there is damage to small blood vessels of the inner layer of the eye. This part of the eye is called the retina and is made of nerve cells. The light entering the eye is converted into an electric impulse inside the retinal nerves, which then “travels” into the brain creating the image that we see. Thus, the retina has a key role in vision. In case of diabetes, it is especially affected because diabetes targets the smallest blood vessels that, when damaged, leak fluid and blood into the layers of the retina and thus damage vision.

The first and most important step in the treatment of retinopathy is its constant and detailed monitoring, even if there are no further visible changes. Furthermore, monitoring depends on how blood sugar is regulated, the type of therapy and the changes that generally occur.

Treatment is performed using a laser, i.e. by using the laser to seal off damaged blood vessels in the retina. If the disease has advanced, a more complex procedure called a VITRECTOMY will be required.

A disease of the central part of the retina, namely the macula, resulting in a loss of vision in the centre of the visual field is called macular degeneration.

It can have two forms: dry and wet.

The dry form of macular degeneration is characterized by cellular debris that accumulates between the retina and the choroid, separating the retina from its substrate, the retinal pigment epithelium. Symptoms include difficulties with reading, difficult visualization of details, the appearance of spots in the centre of the visual field… It occurs in 85% of cases. Unfortunately, there is no effective treatment for dry macular degeneration, but it is extremely important to take a combination of vitamins and omega acids, with high doses of the antioxidant lutein, which has been proved to reduce and slow down dry macular degeneration.

In the wet form, the blood vessels grow out from the choroid, thereby also causing the detachment of the retina from the substrate. The wet form is more severe and occurs in 15% of cases. The most common symptoms include the appearance of bending lines and the deformation of contours of objects caused by the leakage of fluid from the fragile blood vessels. This type of macular degeneration is treated with anti-VEGF medications – injections. The injection results in blocking the growth factors of blood vessels in the eye, which slows down the visual impairment. It is administered under local anaesthesia and the procedure needs to be repeated several times to ensure a better effect.

Laser treatment is applied in a smaller number of cases. This involves the destruction of the fragile newly-formed blood vessels. It is only applied in cases in which the blood vessels are outside the foveola, the central part of the macula.

The OCT has an irreplaceable role in the diagnosis and monitoring of the disease, as it allows us to assess the condition of the macula in a fast and completely non-invasive way. If additional confirmation is necessary to establish the diagnosis, fluorescein angiography will be performed as well.

A small opening in the macula, the part of the retina responsible for central vision, is called a macular hole (rupture of the macula).

With age, the vitreous jelly in the middle of the eye starts to pull away from the macula. The macular tissue stretches creating a small hole, i.e. a rupture. A macular hole is most commonly associated with ageing and occurs in persons older than 60.

If the macular hole is diagnosed at an early stage, the development of symptoms may be avoided. Vision gradually becomes blurred and distorted, and as the disease progresses, a small black patch can develop and interfere with proximity and distance vision. Also, the ability to distinguish details at all distances is reduced and some objects are distorted, appearing as if they are being looked at through fog.

A vitrectomy is the most efficient method of repairing a macular hole. The method of treatment is the surgical removal of the part that is pulling on the macula in order to release it from traction. After that, a mixture of gas and air is injected in the form of a bubble. The air bubbles exert pressure on the macular hole and thus allows healing.

This surgical procedure is necessary to achieve the best possible result in repairing ruptures of the macula. The rupture slowly heals, and the gas and air disappear over time. After the surgery, vision gradually starts to return, with the speed depending on the size of the rupture and the stage in which it was diagnosed.

Regular ophthalmic examinations are of great importance, as persons who have had a rupture in one eye have a greater chance of developing a rupture in the second eye as well.

Identify the problem in time and prevent damage to the eye!

 

Age-related macular degeneration (AMD) primarily affects the elderly.

Although it rarely causes complete loss of vision, impaired central vision significantly affects the quality of life.

Timely identification, quality diagnostics and prompt therapy have a significant impact on the progression of the disease.

AMD treatment depends on the form of the disease.

In case of the dry form of AMD, various antioxidant substances are prescribed. The most common are vitamins C and E, zinc, lutein and numerous other multivitamin preparations intended for macular diseases. Clinical studies have shown that they cannot repair the damage, but can slow down the progression of the disease.

In case of the wet form of AMD, if the damage is far enough from the centre of the macula (fovea), the photocoagulation laser is used. This type of treatment is guided by fluorescein angiography (FAG), which specifically marks the ”stray” blood vessels. This is only the first part of the combined procedure, which is the best form of treatment for this condition.

The second and more important part of macular disease treatment is the intravitreal (in the eye) administration of a medication from the group of synthetic antibodies against vascularization factors. The ”stray” blood vessels additionally damage the macula by releasing exudate and fluid from their poor-quality walls. Anti-VEGF therapy (anti-vascular endothelial growth factor) strengthens the intercellular connections and makes them impermeable, repairing the poor construction of the walls of the newly-formed “stray” blood vessels, and preventing the creation of endothelial cells, the building material of blood vessels.

The intravitreal (intraocular) method of application ensures that the medication is administered in a sufficient concentration and with the greatest effectiveness. Intraocular injections are used to treat many eye diseases, most commonly for the treatment of macular edema in diabetic retinopathy, retinal vein occlusion, inflammatory diseases and the wet form of age-related macular degeneration. This is the preferred method of application for the latest medication intended for the treatment of the wet form of age-related macular degeneration, helping prevent the growth of new blood vessels in the eye (anti-VEGF). Corticosteroids (triamcinolone acetonide and others), intended for treating the edema and the inflammatory changes in the retina, are also administered in this way.

Some of the medications in the anti-VEGF group are:

 

Avastin® (bevacizumab) is a drug primarily used in the treatment of colon cancer, where the non-selective blockage of growth of new blood vessels stops tumour growth. In the last few years, Avastin has been widely used throughout the world for the treatment of the wet form of macular degeneration, and new indications, such as diabetic retinopathy, are also being introduced. Since ocular use represents a so-called “off-label use”, the patient must be fully acquainted with the risks of such use and sign an informed consent before the drug is administered. An advantage of this drug is its price, which is significantly lower than the prices of other drugs.

Macugen® (pegaptanib) selectively blocks the endothelial growth factors of blood vessels in the eye. Its primary indication is the wet form of age-related macular degeneration and it is approved for use in such cases by the US FDA. Its selective action provides far greater safety of application in patients with an increased risk of cardiovascular disease.

Kenalog® (triamcinolone acetonide) is a corticosteroid administered intravitreally to reduce macular edema in diabetic retinopathy, vascular occlusions, the wet form of age-related macular degeneration, in combination with anti-VEGF drugs or laser therapy, for treating certain inflammatory diseases of the eye, and other less common conditions.

If the tear or hole in the retina has not progressed to detachment, our ophthalmologist may suggest one of the following procedures to prevent retinal detachment and preserve vision.

 

Laser surgery (photocoagulation). Laser photocoagulation has been an accepted treatment for a variety of conditions for many years. It is most commonly used in the treatment of diabetic retinopathy, diabetic macular edema, and other retinal vascular diseases, as well as ruptures and minor retinal edema.

Laser treatment of diabetic macular edema and diabetic retinopathy is performed under local anesthesia. The pupil is dilated as much as possible with drops beforehand. The doctor leans the contact lens against the patient's eye.

The procedure takes about 20 minutes and is repeated two or three times.

Diabetes is the leading cause of blindness in the world...

When the pancreas does not produce enough insulin or the body does not use the insulin it produces properly, diabetes, a chronic disease, results.

The main cause of blindness and poor vision in a healthy person is precisely diabetes. Unfortunately, diabetes often damages the eye and not only that, diabetes spares no part of the eye when it occurs.

The worst possible complication in the diabetes-eye connection is diabetic retinopathy.

When diabetic retinopathy is diagnosed, it means that the inner layer of the eye, the retina, which is made up of nerve cells, has been damaged. The light that enters the eye is converted into an electrical impulse in the nerves of the retina that "travels" to the brain, and that is how we see. So, the retina plays an important role in vision in everyone, but is particularly affected in diabetes because it is precisely the "target" of a very small blood vessel.

The changes that occur at the front of the eye may look like the following:

  • stye (on the eyelids).
  • frequent inflammation, conjunctivitis (on the clutch)

- decreased sensitivity of the cornea (neurotrophic keratitis)

- neovascularization of the iris (at the iris)

- reduced ability to see in the distance

- blurred vision

- the occurrence of double vision

The first and most important step in the treatment of retinopathy is constant and detailed monitoring, even if no other visible changes occur. In addition, the controls depend on the blood sugar control, the type of therapy itself and the general changes that have occurred.

The treatment is carried out with the laser, i.e., the damaged parts of the retina are punched with the laser. If the disease is advanced, a more elaborate procedure called VITRECTOMY.

Treat eyes affected by diabetes in a timely manner because the condition can be more serious than it looks. Prevent eye barb or glaucoma from forming unnecessarily!

A retinal ablation or retinal detachment is an emergency that must be operated on as soon as possible, preferably within 24 hours. During ablation, the retina tears and a retinal hole is created. An eye guide is inserted through the retinal hole and the retina is separated from the back of the eye. The entire operation is called a vitrectomy.

Vitrectomy is usually performed on an outpatient basis under local anesthesia. The surgery can take anywhere from an hour to several hours.

During the procedure, the surgeon makes two or three holes in the sclera and uses a microscope to see inside the eye and perform the following steps or more with microsurgical instruments:

- remove the completely opacified vitreous body

- remove scar tissue from the retina

- remove all muttins

- remove all objects that should not be in the eye

- return the retina to its natural position

- repair the torn retina with a laser

- put an air or gas bubble in the eye to keep the retina in the right position (the bubble will be reabsorbed after a while)

- put silicone oil into the eye (the oil will be removed later during the second surgery)

 

Recovery

Vitrectomy procedures are often performed in conjunction with other eye surgeries, so individual recovery times and recommendations will vary.

AND activities such as driving, reading, and sports must be avoided for several years after surgery.

Uni eye drops are prescribed to prevent infection and reduce inflammation.

The recovery process takes between 4 and 6 weeks.

Diabetic retinopathy is a complication of diabetes in the eye.

If it is established that a patient is suffering from diabetic retinopathy, this means that there is damage to small blood vessels of the inner layer of the eye. This part of the eye is called the retina and is made of nerve cells. The light entering the eye is converted into an electric impulse inside the retinal nerves, which then “travels” into the brain creating the image that we see. Thus, the retina has a key role in vision. In case of diabetes, it is especially affected because diabetes targets the smallest blood vessels that, when damaged, leak fluid and blood into the layers of the retina and thus damage vision.

The first and most important step in the treatment of retinopathy is its constant and detailed monitoring, even if there are no further visible changes. Furthermore, monitoring depends on how blood sugar is regulated, the type of therapy and the changes that generally occur.

Treatment is performed using a laser, i.e. by using the laser to seal off damaged blood vessels in the retina. If the disease has advanced, a more complex procedure called a VITRECTOMY will be required.

A disease of the central part of the retina, namely the macula, resulting in a loss of vision in the centre of the visual field is called macular degeneration.

It can have two forms: dry and wet.

The dry form of macular degeneration is characterized by cellular debris that accumulates between the retina and the choroid, separating the retina from its substrate, the retinal pigment epithelium. Symptoms include difficulties with reading, difficult visualization of details, the appearance of spots in the centre of the visual field… It occurs in 85% of cases. Unfortunately, there is no effective treatment for dry macular degeneration, but it is extremely important to take a combination of vitamins and omega acids, with high doses of the antioxidant lutein, which has been proved to reduce and slow down dry macular degeneration.

In the wet form, the blood vessels grow out from the choroid, thereby also causing the detachment of the retina from the substrate. The wet form is more severe and occurs in 15% of cases. The most common symptoms include the appearance of bending lines and the deformation of contours of objects caused by the leakage of fluid from the fragile blood vessels. This type of macular degeneration is treated with anti-VEGF medications – injections. The injection results in blocking the growth factors of blood vessels in the eye, which slows down the visual impairment. It is administered under local anaesthesia and the procedure needs to be repeated several times to ensure a better effect.

Laser treatment is applied in a smaller number of cases. This involves the destruction of the fragile newly-formed blood vessels. It is only applied in cases in which the blood vessels are outside the foveola, the central part of the macula.

The OCT has an irreplaceable role in the diagnosis and monitoring of the disease, as it allows us to assess the condition of the macula in a fast and completely non-invasive way. If additional confirmation is necessary to establish the diagnosis, fluorescein angiography will be performed as well.

A small opening in the macula, the part of the retina responsible for central vision, is called a macular hole (rupture of the macula).

With age, the vitreous jelly in the middle of the eye starts to pull away from the macula. The macular tissue stretches creating a small hole, i.e. a rupture. A macular hole is most commonly associated with ageing and occurs in persons older than 60.

If the macular hole is diagnosed at an early stage, the development of symptoms may be avoided. Vision gradually becomes blurred and distorted, and as the disease progresses, a small black patch can develop and interfere with proximity and distance vision. Also, the ability to distinguish details at all distances is reduced and some objects are distorted, appearing as if they are being looked at through fog.

A vitrectomy is the most efficient method of repairing a macular hole. The method of treatment is the surgical removal of the part that is pulling on the macula in order to release it from traction. After that, a mixture of gas and air is injected in the form of a bubble. The air bubbles exert pressure on the macular hole and thus allows healing.

This surgical procedure is necessary to achieve the best possible result in repairing ruptures of the macula. The rupture slowly heals, and the gas and air disappear over time. After the surgery, vision gradually starts to return, with the speed depending on the size of the rupture and the stage in which it was diagnosed.

Regular ophthalmic examinations are of great importance, as persons who have had a rupture in one eye have a greater chance of developing a rupture in the second eye as well.

Identify the problem in time and prevent damage to the eye!

 

Degenerativna senilna bolest makule ili žute pjege (skraćeno AMD) primarno zahvaća stariju populaciju.

Iako je rijetko uzrokom potpunog gubitka vida, slabeći centralni vid bitno utječe na kvalitetu života.

Pravodobno otkrivanje, kvalitetna dijagnostika i promptna terapija bitno utječu na progresiju bolesti.

Liječenje AMD-a ovisi o formi bolesti.

Kod suhe forme AMD-a propisuju se razne antioksidacijske tvari. Najčešće su to vitamini C i E, cink, lutein te brojni drugi multivitaminski pripravci namijenjeni bolestima žute pjege. Kliničke studije pokazale su da oni ne mogu popraviti nastalo oštećenje, ali mogu usporiti progresiju bolesti.

Kod vlažne forme AMD-a, ako se oštećenje nalazi dovoljno daleko od centra makule (foveje), primjenjuje se fotokoagulacijski laser. Takva terapija provodi se vođena fluoresceinskom angiografijom (FAG), koja točno označava “divlje” krvne žilice. Ova terapija samo je dio kombiniranog zahvata kao najbolje terapije.

Drugi, važniji dio terapije bolesti žute pjege jest intravitrealna (u oko) primjena lijeka iz skupine sintetskih protutijela protiv faktora vaskularizacije. Upravo divlje krvne žilice dodatno oštećuju makulu, ispuštajući eksudat i tekućinu iz svojih nekvalitetnih krvnih stijenki. Anti-VEGF terapija (anti-vascular endothelial growth factor) ojačava i čini nepropusnim međustanične spojeve, popravljajući tako lošu građu stijenki novonastalih, divljih krvnih žila, te sprječava poticanje stvaranja stanica endotela, građevnog materijala krvnih žila.

Intravitrealna (intraokularna) primjena lijeka, na mjestu samog patološkog zbivanja, osigurava dovoljnu koncentraciju i najjaču učinkovitost lijeka. Intraokularne injekcije koristimo za liječenje brojnih bolesti oka, najčešće za liječenje makularnog edema kod dijabetičke retinopatije, okluzija vena mrežnice, upalnih bolesti i vlažnog oblika senilne makularne degeneracije. Na ovaj se način primjenjuju najnoviji lijekovi za liječenje vlažnog oblika senilne makularne degeneracije, koji sprječavaju rast novih krvnih žilica u oku (anti-VEGF) i kortikosteroidi (triamcinolon acetonid i sl.), kojima se djeluje na edem i upalne promjene na mrežnici.

Navodimo nekoliko lijekova iz skupine anti-VEGF:

Lucentis® (ranibizumab) neselektivni je anti-VEGF lijek za liječenje vlažnog oblika makularne degeneracije, jedini službeno odobren za očnu primjenu, s dobrim rezultatima iz brojnih multicentričnih kliničkih studija.

Avastin® (bevacizumab) je lijek koji se primarno koristi u liječenju karcinoma debelog crijeva, gdje neselektivnim blokiranjem rasta novih krvnih žila zaustavlja i rast tumora. Avastin se zadnjih nekoliko godina u cijelom svijetu uvelike primjenjuje za liječenje vlažnog oblika makularne degeneracije, a otvaraju se i nove indikacije poput dijabetičke retinopatije. Budući da primjena u oku predstavlja tzv. “off label use” (upotreba izvan preporučene indikacije),  pacijent se prije zahvata mora u potpunosti upoznati s rizicima takve primjene te potpisati informirani pristanak. Prednost ovog lijeka je što je dosta jeftiniji od drugih.

Macugen® (pegaptanib) selektivno blokira endotelijalne faktore rasta krvnih žila u oku. Njegova primarna indikacija je vlažna forma senilne makularne degeneracije i odobren je od američke agencije FDA za tu indikaciju. Njegovo selektivno djelovanje pruža daleko veću sigurnost primjene kod bolesnika s povećanim rizikom za kardiovaskularne bolesti.

Kenalog® (triamcinolon acetonid) je kortikosteroid koji se daje intravitrealno u cilju smanjenja makularnog edema kod dijabetičke retinopatije, vaskularnih okluzija, kod vlažnog oblika senilne degeneracije žute pjege, u kombinaciji s anti-VEGF lijekovima ili laserskom terapijom, nekih upalnih bolesti oka i drugih rjeđih stanja.

If the tear or hole in the retina has not progressed to detachment, our ophthalmologist may suggest one of the following procedures to prevent retinal detachment and preserve vision.

 

Laser surgery (photocoagulation). Laser photocoagulation has been an accepted treatment for a variety of conditions for many years. It is most commonly used in the treatment of diabetic retinopathy, diabetic macular edema, and other retinal vascular diseases, as well as ruptures and minor retinal edema.

Laser treatment of diabetic macular edema and diabetic retinopathy is performed under local anesthesia. The pupil is dilated as much as possible with drops beforehand. The doctor leans the contact lens against the patient's eye.

The procedure takes about 20 minutes and is repeated two or three times.

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