Diabetic retinopathy

Description:

Diabetic retinopathy — one of the heaviest complications of a diabetes mellitus the manifestation of a diabetic mikroangiopatiya striking vessels of a mesh cover  of an eyeglobe, observed at 90% of patients at a diabetes mellitus. Most often develops at a long current of a diabetes mellitus, however timely ophthalmologic inspection allows to reveal development of a retinopathy at an early stage. A vision disorder — one of disabling manifestations of a diabetes mellitus. The blindness at patients with a diabetes mellitus comes by 25 times more often than among the persons who do not have this illness.

Symptoms of the Diabetic retinopathy:

Initial stages of defeat are characterized by lack of eye symptoms (decrease in visual acuity, pain and others). Loss or decrease in visual acuity — the late symptom signaling about far come, irreversible process (it is not necessary to neglect to modern planned ophthalmologic researches).

The main reason for loss of sight — a diabetic retinopathy which various displays come to light at 80 — 90% of patients. According to the academician Yefimov A. S., at an ophthalmologic research of 5 334 persons with a diabetes mellitus the retinopathy of various degree of manifestation is revealed at 55,2% of patients (the I stage — 17,6%, the II stage — 28,1%, the III stage — at 9,5%). Total loss of sight among all inspected made about 2%.

Retinopathy — defeat of vessels of a retina. Main "targets" for structural changes in a retina:

  1. arterioles — lipogialinovy arteriosclerosis ("plasmatic васкулёз"), precapillary arterioles and capillaries in back area of an eyeground are most struck;
  2. veins — expansion and deformation;
  3. capillaries — dilatation, increase in permeability, the local obstruction of capillaries causing perikapillyarny swelled; a degeneration of intraparietal pericytes with proliferation of an endothelium, a thickening of basal membranes, formation of microaneurysms, hemorrhages, arteriovenous shunts, neovascularization;
  4. the swelling of striatum opticum fibers which is looked through as gray areas and oblakovidny spots, the expressed exudates, a papilledema, an atrophy and amotio of a retina.

Reasons of the Diabetic retinopathy:

The main etiogichesky factor - it is long the existing hyperglycemia. There is an opinion on value of an immune factor in a retinopathy origin.

Treatment of the Diabetic retinopathy:

Treatment of a diabetic retinopathy complex, is carried out by the endocrinologist and the oculist. The healthy nutrition and an insulin therapy has important value. It is important to limit fats in a diet, to replace fat of animal origin vegetable, to exclude the easily acquired carbohydrates (sugar, candies, jam), and also to widely use the products containing lipotropic substances (cottage cheese, fish, grits), fruit, vegetables (except potatoes). Important value is allocated for vitamin therapy, especially by groups B (B1, B2, B6, B12, B15) inside and parenterally. C, P, E vitamins have tire-tread effect on a vascular wall (3 — 4 times a year, a course 1 month). Treat vasoprotectives ангинин (Prodectinum), Dicynonum, Doxium. Drugs accept on doctor's orders.

    * At a diabetic retinopathy of the I stage (not proliferative retinopathy) frequent repeated ophthalmologic researches are shown. The doctor has to check, how correctly the patient controls glucose level in blood.
    * At a diabetic retinopathy of II or III stages (respectively a preproliferativny and proliferative retinopathy) laser photocoagulation is shown.

During the recent research DIRECT use of a blocker a renin-angiotenzinovykh of receptors (RACES) of a kandesartan was estimated at a diabetes mellitus 1 and 2 types. Use of a kandesartan did not reduce progressing of a retinopathy. During the research the tendency to decrease in weight of a retinopathy was noted. In less extensive research RASS it was shown that development of a retinopathy at a diabetes mellitus of 1 type is slowed down at blockade of RACES by means of a losartan and inhibitor of an angiotensin-converting enzyme of enalapril. Thus, patients can have a reasonable use of blockers of RACES with diabetes of 1 type and a retinopathy, but not at diabetes of the 2nd type.