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Treatment of retina
- What are the methods of treatment age-specific macular degenerations?
- In some cases laser treatment can be effective with the purpose of stop progressing of disease. In our clinic is used the diode laser. It is irreplaceable at treatment of various kinds of pathology of retinal macular area as xanthophyllic yellow pigment of macula poorly absorbs its radiation and thereof the layer of nervous fibres is spared. With same purpose is recommended using of medical products (vasodilating, improving rheology of blood, antioxidants, vitamin preparations). In each separate case is chosen the individual scheme and sequence of medical actions.
- In what is essence of laser treatment at diabetes?
- As defeat of retina at a diabetes has secondary character, the system treatment of the basic disease - the careful control of levels of glucose in blood, arterial pressure, functions of kidneys is the extremely important before performance of laser procedure. Laser treatment is carried out out-patient and is most widely used method of treatment at diabetic retinopathy and macular edema. The essence of laser influence comes to destruction of avascular parts of retina, which is a source of secretion of factors of new-formed vessels growth.
To get the return development or reduction of neovasculariztion and, to reduce the risk of haemorrhages in vitreous body and other unpleasant consequences thus has decreased, it is necessary to coagulate (cauterize by laser) from 1/5 up to 1/3 surfaces of retina by scarring. In 75 % of cases this purpose is achieved, and then the probability of a haemorrhage and retinal detachment is sharply reduced owing to its tension (tractions).
At pre-proliferative or proliferative DR laser burns are caused on all retina, excepting its central parts (panretinal lasercoagulation).
New-formed vessels also are exposed to laser influence. The given method is especially effective at the early beginning of treatment, long-time warning blindness in 90 % and more cases. In the advanced situations efficiency of lasercoagulation is strongly reduced.
In case of macular diabetic edema the central parts of retina are exposed to laser influence. Long duration of treatment’s effect is substantially defined by the general condition of the patient.
- In what is the essence of surgical treatment of eye diabetes complications?
- If illness is at a traction stage of vitreous body with retinal detachment, massive internal haemorrhages or advanced proliferative retinopathy, then the laser coagulation is in most cases contra-indicated, in this case is necessary surgical intervention on vitreous body - vitrectomy.
Its essence consists at ablation from an eye cavity of grumes, the grown turbid portions of vitreous body and cicatricial cords on a surface of retina. Aspiration of vitreous bodiy is made in maximum full volume. If it’s possible, the back hyaloid membrane, placed between a retina and vitreous body, and playing the important role in development of proliferative retinopathy removes.
- Is there a sense in conservative treatment of eye displays of a diabetes?
- At a fresh haemorrhage in vitreous body (hemophthalmia) the patient is recommended to carry out a maximum of time sitting or laying with a high headboard blindly. This simple method promotes thrombose of a bleeding vessel and to sedimentation of blood elements in the bottom parts of an eye cavity under influence of gravitation. After sufficient increase of transparency of an eye optical medium, is made laser treatment of diabetic retinopathy. If within 1 month of it does not occur, it is usually carried out vitrectomy.
Medicinal therapy of diabetic retinopaty and hemophthalmia - one of the most inconsistent sections of modern ophthalmology. On the one hand, on the given question there are a plenty of researches and proceeds active search of medical preparations. On the other hand, for today there are no medicamentous preparations which efficiency in treatment of diabetic retinopathy is proved. In modern foreign manuals on conducting of diabetic retinopathy and hemophthalmia, the methods of their medicinal treatment either are not analyzed, or mentioned in brief in section perspective development.
For this reason in system of public health services of the majority of the countries with the insurance organization of medicine, conservative therapy of diabetic retinopathy is not carried out and the standard methods of treatment of patients with DR are: system conducting of diabetes, laser coagulation and surgical treatment of eye complications of diabetes. Thus, for today a method of a treatment choice of eye diabetes complications is laser coagulation of retina. In advanced cases carrying out of surgical treatment is indicated. Medicinal therapy of diabetic retinopathy is a subject of perspective scientific researches and has no sufficient bases for wide application in practical ophthalmology. Traditionally carried out in many eye hospitals of Russia conservative treatment of patients with DR is not only an example of the irrational charge of budgetary funds, but also one of the main reasons of the late visit of patients for laser treatment.
- How the peripheral degeneration of retina is treated?
- For duly treatment of peripheral degenerations and prevention of development of retinal detachment from high-risk group (see above) it is recommended for patients to pass routine inspection periodically (one - two times one year) at the experts owning skills of survey of eye grounds periphery. Usually laser surgeons make it, since for revealing of the retinal dystrophies, breaks or, in some cases, initial retinal detachment the special equipment and special methods of inspection are used. During inspection the laser surgeon makes a decision - or to recommend to the patient dynamic supervision, or to carry out peripheral preventive delimital laser coagulation of retina ("laser welding").
This easily transferable out-patient procedure allows delimit the struck parts of retina and not to give to detachment to be distributed in direction of the central parts of an eye grounds. Due to this procedure after duly survey thousand patients avoid heavy operations and incapacitation.
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