Diabetic Retinopathy

(Bleeding due to diabetes) Intravitreal Antivegf/Ozurdex Injection-Micropulse Lazer Photocoagulation,PRP Growth Factor Injection and Magnovision Therapy. The eyeball consists of refractive media, from front to back, that focus light on the retina. The cornea at the front and the lens behind it focus the light on the macula (yellow dot), the area of ​​the retina that provides sharp vision.

The eyeball consists of 3 layers from the inside to the outside: the retina is the innermost, the vascular layer in the middle and the white of the eye, which gives the eyeball its rigidity.

Objects can be seen when the rays coming from the objects focus on the macula (yellow dot).
There are cells in the retina that convert light energy into electrical energy and transmit it to the brain.

The retina consists of millions of nerve cells. There is a widespread vascular network that nourishes and oxygenates these cells.

Diabetes mellitus, in other words, deteriorates the structure of small vessels over the years and causes occlusion of these vessels.

The retina in the eye, the glomeruli in the kidneys and the foot veins are the most rapidly occluded vessels. If diabetes cannot be kept under control, it can cause retinal hemorrhages and blindness, kidney failure and dialysis dependence, non-healing wounds on the feet and gangrene within 5 years.Good metabolic control is achieved by keeping not only sugar but also hypertension and blood fats/cholesterol under control. The combined control of these blood values ​​minimizes the risk of occlusion in the eye vessels.

Even if blood sugar is well controlled, it is very important for those with diabetes mellitus for more than 10 years to have an eyeball check at least every 6 months, even if they have no complaints.

As diabetes progresses and is not kept under control, respectively:

* Deterioration of capillaries in the retina,* Bubbling called microaneurysm* Serum and oil leaks called hard exudate,* bleeding into the retina,* Edema and decreased vision in the macula, ie yellow spot,* New vessel formations that are suitable for bleeding,* Bleeding of newly formed vessels, forming bands/membranes in the eye, causing shrinkage and tears in the retina.

As a result of all these processes, permanent vision loss or blindness occurs.

The visual quality of the patient decreases very much due to bleeding and leaks from retinal vessels.

Patchy images occur due to bleeding and leaks.

If both hemorrhage and macular edema are present, refraction and patchy images occur in the objects examined.

Sometimes, only macular edema occurs without bleeding, objects may appear broken/distorted or large-small.

Management and treatment:

– Good metabolic control- Adjusting drug or insulin doses by following the patient’s internal medicine or endocrinology specialist; investigation of anemia and sleep apnea syndrome,

– Keeping hypertension and blood fats/cholesterol under control,

– Specialized follow-up of adolescent and pregnant diabetes patients- Arrangement of daily-weekly-monthly diet list by dietician- Directing smokers to smoking cessation outpatient clinics and

abstinence from alcohol

– 30 minutes walking a day

Without a good metabolic control, the efforts of the ophthalmologist cannot give good results!!!

– In the early stages that do not impair vision, fundus control and necessary retinal imaging analyzes are performed every 3-4 months. If the nutrition of the retina is not impaired during the microbleeding and leakage stage, growth factor injections can be made outside the eye (prp) and applied together with magnovision if necessary.3) If macular edema has developed or is at a level that threatens vision, micropulse laser that does not burn is applied to the retinal areas with impaired nutrition: to resolve macular edema, intraocular injections of anti-VEGF or long/slow release steroids are administered. The micro pulse laser provides the secretion of growth factors from the tissues, which are necessary to repair the retina and strengthen the retinal vessels.4) If new vessel formations suitable for proliferative bleeding have developed, this stage is the most critical stage that can cause blindness to develop.

Since these vascular tangles can cause retinal/vitreous hemorrhages, shrinkage and tears in the retina, laser is applied to the entire periphery (pan retinal laser photocoagulation) by protecting the center of the retina.

In the new vessel formation phase; Intraocular injections are applied with laser to dry the vessels that cause bleeding and shrinkage risk.

If the new vessel formation phase cannot be controlled, severe hemorrhages, shrinkages and tears occur in the retina.

Intraocular hemorrhages and retinal detachment are repaired by vitrectomy surgery. However, at this stage, serious damage and cell death have occurred in the retina. Stopping the disease before it reaches these stages positively affects the visual result.

Magnovision support with extraocular injection of growth factors (PRP) may be required to contribute to retinal repair after vitrectomy surgery.