Tag: proliferative diabetic retinopathy

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Diabetic retinopathy Treatments

Vitrectomy for Diabetic Retinopathy

Proliferative Diabetic Retinopathy Causes Vitreous Hemorrhage and Diabetic Retinal Detachment

There are two times when a patient needs vitrectomy eye surgery for diabetic retinopathy.  Patients with either a vitreous hemorrhage and/or a diabetic retinal detachment will require a vitrectomy.

Both occur when the diabetic retinopathy has advanced to “proliferative diabetic retinopathy.”  By definition, abnormal blood vessels, called neovascularization have developed somewhere on the retina.

Neither case requires emergency surgery.

What is Proliferative Diabetic Retinopathy

Neovascularization, the abnormal blood vessels, is very fragile.  These delicate blood vessels have grown somewhere inside the eye; usually on the surface of the retina.

There are 3 types of neovascular tissue named based on the location;  neovascularization elsewhere (NVE), neovascularization of the disc (NVD) or neovascularization on the iris (NVI).

Regardless, just remember proliferative diabetic retinopathy, by definition, means abnormal blood vessels are somewhere in the eye!

Vitreous Hemorrhage

At times, these delicate blood vessels may bleed and cause a vitreous hemorrhage.  Blood accumulates inside the eye and blocks the vision.  Patients can’t see “out” and doctors can’t see “in.”

Though the vision loss can be dramatic, and as long as nothing else could have caused the bleeding (i.e. a retinal tear can also cause a vitreous hemorrhage), we usually wait for the blood to clear.  This may take several weeks or longer.

If the blood doesn’t clear, a vitrectomy is needed to remove the blood not absorbed by mother nature.

Diabetic Retinal Detachment

Untreated neovascular tissue may “proliferate” or grow inside the eye.  The tissue may creep along the surface of the retina much the same way ivy grows along the ground…moving slowly from one point to another.

With time, the NV may contract and start to detach the retina.  This type of “traction” retinal detachment is different than retinal detachments sustained by non-diabetic patients.

A retinal detachment caused by diabetes requires vitrectomy surgery to physically cut away or remove the offending tissue pulling up on the retina.

What Does This Mean?

In both cases, laser treatment (panretinal photocoagulation or PRP) is needed to stop the neovascularization.

In the case of a vitreous hemorrhage, if the blood is not absorbed, laser can be performed at the same time as the operation.  If the blood does absorb, laser treatment can be performed in the office.

For patients with a diabetic retinal detachment; however, an operation is often the best and only choice.

With routine eye examination, the neovascular tissue is often detected before bleeding or retinal detachment has occurred.  Treatment can be initiated, operations avoided, and vision preserved!

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Diabetic retinopathy Retina Treatments

Sometimes You Just Need a Vitrectomy

A vitrectomy is an eye operation. It is performed by retina specialists for a variety of reasons. In patients with diabetic retinopathy, a vitrectomy may be useful to remove blood in the vitreous, aka a vitreous hemorrhage. There is no reason, to perform a vitrectomy in cases of macular degeneration.

Vitrectomy Surgery to Clear Hemorrhage
Vitrectomy Surgery to Clear Hemorrhage

In cases of vitreous hemorrhage, bleeding has and blood remains suspended in the vitreous. The vitreous is the gel-like substance that fills most of the eye. It is very similar to jellyfish, it has substance, but is mostly water.  It is optically clear.

A vitreous hemorrhage is benign, that is, the blood does not cause any damage to any portion of the eye, especially the retina. The vitreous hemorrhage physically blocks light and causes loss of vision. Sometimes the vitreous hemorrhage can absorb on its own, but if not, a vitrectomy is necessary to remove the non-clearing vitreous hemorrhage. At this point vision should be restored. It can take weeks or months to absorb. Many times we can’t wait that long.

Advanced diabetic retinopathy, or proliferative diabetic retinopathy, can have a retinal detachment associated with it. This type of retinal detachment is different. Most retinal detachments are caused by a retinal tear or retinal hole, called a “rhegmatogenous” retinal detachment.

Retinal detachments associated with diabetic retinopathy are called “traction” retinal detachments. The mechanism is different than rhegmatogenous retinal detachments in that the retina is pulled, like a tent, apart from the underlying layers. “Scar” tissue has formed on the surface of the retina, contracted and exerts this pulling.

A vitrectomy is necessary to correct/repair this type of retinal detachment. The vitreous is removed to allow access to the retinal surface. The abnormal scar tissue is cut away to relieve the “pulling.”

Vitrectomy surgery is also used for other retinal problems; rhegmatogenous retinal detachments, epiretinal membranes, macular holes, floaters, certain trauma, etc. Major risks of the surgery include blindness from infection and retinal detachment. The risks, however, are very, very uncommon.

Vitrectomy surgery has been around  for about 30 years.  It has allowed us to prevent potentially blinding retinal detachments in our diabetic retinopathy patients.  On the other hand, the whole focus of this site is to educate.  If you are seen early enough, you’ll never even need a vitrectomy.

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax Virginia

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Diabetic retinopathy Retina Retinal Detachments

Diabetes and Retinal Detachments

Two types of retinal detachments. One group, called rhegmatogenous retinal detachment, can occur in any one and involves the formation of a tear or hole in the retina.  The second group, called traction retinal detachments, involves tissue forming on the surface of the retina and “pulling” the retina to form a detachment.  This is the case with diabetic related retinal detachments.

Maintain Your Perspective While Reading! Remember fewer than 0.3% of patients with diabetes now (as of 2007) suffer severe vision loss.  Retinal detachment in diabetics is the most common way a diabetic can lose significant vision, including blindness.

There are several stages of diabetic retinopathy.  The proliferative phase, by definition, involves the formation of neovascularization (new, abnormal blood vessels) on the surface of the retina.  As ivy may creep along the forest floor, these abnormal vessels may creep along the surface of the retina.

At some point the neovascular vessels, reaching from “Point A” to “Point B,” begin to contract, pull up on the retina and cause a retinal detachment.  The neovascular vessels cause “traction” on the retinal surface thereby pulling the retina apart.

Retinal Detachments Can Blind. Left untreated, the retinal detachment may spread and eventually detach the macula (the functional center of the retina).  The prognosis for restoration of vision is poor when a diabetic retinal detachment involves the macula.  This is the basic mechanism by which diabetes may lead to blindness.

Vitrectomy surgery is indicated to literally cut away the offending neovascular complex.  Intraocular surgery, also known as a vitrectomy, is required to gently separate the abnormal surface tissue from the underlying retina.  If successful, the retina may be reattached and the vision, and retina, becomes stable.

Too often, patients are unaware that a retinal detachment has formed.  The macula may be still attached and, though misleading, the vision is still quite useful.  Many other times, patients may have lost significant vision in one eye and retain good vision in the other.  Believe it or not, many patients are unaware of significant vision loss when only one eye is affected.

Recommendations for diabetic eye exams include routine visits to look for disease while the vision is still good.  This stuff is usually preventable and avoidable!

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

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Diabetic retinopathy

Diabetes Unlikely to Cause Blindness

Today’s post is about one of my own observations from over 15 years in practice.  While it is a fact that significant vision loss from diabetes is declining, it is not widely known that there is also a very finite time where patients with diabetes can go blind, there is only a finite time while the risk of blindness is highest.  In short, the chance of a diabetic patient going blind these days is much less than 0.5%, especially when under the care of an eye doctor.

Let me explain. Recently, I wrote about the decline in the incidence of diabetic patients going blind.  The statistics say that severe vision loss was reduced to about 0.3% by 2005-2007 (read the article “Vision Problems in Type I Diabetes on the Decline”).  This is truly great news.

I have two observations; 1)  I have never had a patient with diabetes go blind if I had been following them before they developed any complications from proliferative diabetic retinopathy, and 2)  in most cases, when patients develop signs of proliferative diabetic retinopathy, the retinopathy usually becomes controlled within a year and becomes stable.  This means they are highly unlikely to lose vision or to go blind.  The patients that have gone blind usually wait until they have lost vision before seeking medical attention.

What does this mean? There are two major points.  My observations are consistent with published data that correlates early detection of diabetic retinopathy with an excellent long term visual prognosis.  In other words, the earlier we can detect diabetic retinopathy, the better chance that you will never lose vision.  Second,  there is a small window of a year or so (my personal observation) that patients are susceptible to vision loss once proliferative changes are noted.  Once diagnosed with proliferative diabetic retinopathy, a patient is NOT destined to loss of vision or blindness.

So, chances are that most diabetics will not lose vision.  We are stressing early examination to detect diabetic retinopathy early.  Last, diabetics are not a ticking timebomb; waiting for blindness to ensue.

It’s really good news that seems to get lost in this information gap.

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

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