What Are Diabetic Retinopathy Symptoms?

Diabetic retinopathy (DR) is the most important manifestation of diabetic microangiopathy, a fundus lesion with specific changes, and one of the severe complications of diabetes. Clinically, according to the presence or absence of retinal neovascularization, diabetic retinopathy without retinal neovascularization is called non-proliferative diabetic retinopathy (NPDR) (or simple or background type), and there will be retinal neovascularization. The resulting diabetic retinopathy is called proliferative diabetic retinopathy (PDR).

Basic Information

nickname

Diabetic retinopathy

English alias

diabeticretinitis

Visiting department

Ophthalmology

Common symptoms

Microaneurysms, bleeding spots, hard exudation, cotton wool spots, vein beading, intraretinal microtubular abnormalities (IRMA), macular edema

Causes of diabetic retinopathy

Diabetic patients mainly have abnormal insulin metabolism, causing changes in ocular tissues, nerves and blood vessels, resulting in damage to eye nutrition and visual function. Microvessels refer to tiny blood vessels and capillary networks between the tiny arteries and veins with a lumen less than 100 to 150 µm, and are the place where tissue and blood exchange materials. Vascular endothelial cell dysfunction caused by the changes in blood composition of diabetic patients, and the blood-retinal barrier is damaged. The association between retinal capillary endothelial cytochrome epithelial cells is destroyed, causing leakage of small blood vessels. Microangiopathy in diabetic patients mainly occurs in the retina and kidney, and is the main cause of blindness, renal failure and death.

Clinical manifestations of diabetic retinopathy

The retinal capillary lesions are aneurysms, bleeding spots, hard exudation, cotton wool spots, vein beading, intraretinal microvascular abnormalities (IRMA), and macular edema. Extensive ischemia can cause retinal or optic disc neovascularization, preretinal hemorrhage, and traction retinal detachment. The patient has severe visual impairment.

Diabetes can cause two types of retinopathy, proliferative and non-proliferative retinopathy. Diabetic retinopathy is one of the major causes of blindness.

In proliferative retinopathy, retinal damage stimulates the growth of new blood vessels. The growth of new blood vessels is not good for the retina, it can cause fibrous hyperplasia, and sometimes retinal detachment. New blood vessels can also grow into the vitreous, causing vitreous hemorrhage. Compared with non-proliferative retinopathy, proliferative retinopathy is more harmful to vision, which can cause severe vision loss or even complete blindness.

Examination of diabetic retinopathy

Blood glucose check

Monitor blood glucose levels regularly to monitor the development of diabetes.

2. Renal function test

Find diabetic nephropathy complications in time.

3. Cholesterol and lipid test

Detect cholesterol and blood lipid levels.

4. Fundus fluorescein angiography

If diabetic retinopathy has not been found under fundus, fundus fluorescein angiography may appear abnormal fluorescence morphology. Microhemangiomas found under fundus fluorescein angiography are much earlier and far more visible than fundus microscopy. Others, such as capillary dilatation, increased permeability, no perfusion area, arteriovenous abnormalities, exudation and bleeding, neovascularization, etc., fundus fluorescence angiography have special manifestations.

5. Oscillation potentials of electroretinograms (OPs)

OPs is a subcomponent of electroretinogram (ERG), which can objectively and sensitively reflect the blood circulation status of the inner retina. It can reflect the abnormal amplitude of OPs in the eyes without lesions in the fundus. In patients with diabetic retinopathy, it can further show the progress and improvement of the disease course.

6. Other inspections

Such as visual contrast sensitivity examination, it can be seen that the average contrast sensitivity of early and middle spatial frequencies is significantly reduced. Color Doppler flow imaging technology can be used to detect changes in arterial hemodynamics in patients with posterior bulbs, which are characterized by low flow, low flow, and high resistance changes. Blood viscosity testing can show increased viscosity. Detection of serum SOD vitality can be manifested as decreased vitality.

Treatment of diabetic retinopathy

Drug treatment

(1) Long-term control of diabetes The fundamental treatment for diabetic retinopathy is the treatment of diabetes. In principle, blood glucose should be controlled to normal or near-normal levels first and often.

(2) Lowering blood lipids For diabetic patients with high blood lipids and circular hard exudation in and around the macular area of the retina, a low-fat diet should be taken and lipid-lowering drugs should be applied.

(3) Control of blood pressure Elevated blood pressure can aggravate diabetic retinopathy. When hypertension is controlled, the leakage of fluorescence is significantly reduced. Therefore, patients with diabetes and hypertension should be controlled for blood pressure. Oral angiotensin-converting enzyme inhibitors have a reducing effect on diabetic retinopathy, which may be related to its antihypertensive effect.

(4) Daoshengming It is said that Daoshengming (calcium 2,5-dihydroxybenzenesulfonate) has "three high" factors leading to diabetic retinopathy: high capillary permeability, high blood viscosity, Platelet high activity has obvious inhibition and reversal effects.

(5) Aspirin can inhibit the formation of thromboxane and prostaglandin metabolites, inhibit platelet aggregation, and have a certain preventive effect on microthrombosis.

2. Photocoagulation therapy

Laser treatment is considered an effective method for treating diabetic retinopathy. Clinical experiments have shown that photocoagulation has a beneficial effect on the pathogenesis of the disease in two aspects: one is to cause the degradation of new blood vessels and prevent them from regenerating; the other is to reduce macular edema.

3. Condensation treatment

Condensation is mainly used in patients who are not suitable for photocoagulation or supplementary therapy for photocoagulation, such as patients with refractive interstitial opacity or peripheral retinal lesions that cannot be treated with photocoagulation.

4. Vitrectomy

For diabetic retinopathy, the basic indications for vitrectomy are vitreous hemorrhage and severe proliferative lesions. It is generally believed that vitrectomy should be performed for those who cannot absorb spontaneously for more than 3 months.