Proliferative Diabetic Retinopathy
What Is proliferative diabetic retinopathy?
High blood sugar levels cause damage to the fine vessels that supply blood to the retina, the light-sensitive tissue inside your eyes. As this damage accumulates, your doctor can begin to see the earliest signs of diabetic changes in your retina – distortion of the vessels and tiny retinal hemorrhages. When the damage has not progressed to the point where new, abnormal blood vessels are growing to try to replace damaged ones, then we call the diabetic damage “nonproliferative diabetic retinopathy.”
Learn more about Proliferative Diabetic Retinopathy
How do these abnormal blood vessels cause eye damage?
Neovascular vessels, the abnormal blood vessels that grow in proliferative diabetic retinopathy, can bleed abruptly into the middle of the eye, causing a vitreous hemorrhage. Additionally, neovascularization produces scar tissue, which can pull the retina off the interior wall of the eye, creating a situation known as a tractional retinal detachment. New blood vessels may grow on the iris, or the colored part of the front of the eye leading to a painful and blinding rise in eye pressure known as neovascular glaucoma
How is the diagnosis of proliferative diabetic retinopathy made?
The first step is a careful eye exam where both pupils are dilated. If new blood vessel growth is suspected, you may need a special test called a fluorescein angiogram. This is a photographic study of the back of the eye performed after an orange-colored dye is injected in a vein in the hand or arm. The dye circulates through the body into the eye to highlight abnormal vessels, or where treatment is needed. If the eye is too filled with blood to examine, your doctor can perform a quick and painless evaluation of the eye’s internal structure with sound waves. This kind of “sonar” for the eye is called an ocular ultrasound.
How is proliferative diabetic retinopathy treated?
In addition to optimizing blood glucose and blood pressure control, there are several treatments available that aim to arrest further vision loss and restore lost retinal function where possible. Anti-vascular endothelial growth factor (anti-VEGF) medication injections into the eye are highly effective at reversing the growth of abnormal retinal blood vessels in proliferative diabetic retinopathy. These injections require repeat treatments to prevent recurrent growth of the abnormal blood vessels over time. Laser photocoagulation is another of the most common treatments for proliferative diabetic retinopathy that has been used for decades with success. In this kind of procedure, brief spots of bright light are scattered through the sides of the retina to reduce abnormal blood vessel growth and help seal the retina to the back of the eye. It is a proven way to reduce the risk of bleeding and retinal detachment. Laser surgery may need to be repeated several times. If you have very advanced proliferative diabetic retinopathy, a vitreous hemorrhage that will not clear on its own, or a retinal detachment, your doctor may recommend a surgery called a vitrectomy. During a vitrectomy, the surgeon removes the blood-filled vitreous and replaces it with saline, clearing the way for additional laser treatment. A vitrectomy is performed in the hospital or outpatient surgery center with anesthesia. The surgeon will use a special microscope to look into your eye, and will perform the procedure using microsurgical instruments. In particularly severe cases, more than one vitrectomy surgery may be necessary.
Vitrectomy Surgery for Proliferative Diabetic Retinopathy
Laser photocoagulation is one of the most common treatments for diabetic retinopathy. In this kind of surgery, brief spots of bright light are scattered through the sides of the retina to reduce abnormal blood vessel growth and help seal the retina to the back of the eye. It is a proven way to prevent bleeding and retinal detachment. Laser surgery may need to be repeated several times. If you have very advanced proliferative diabetic retinopathy, a vitreous hemorrhage that will not clear on its own, or a retinal detachment, your doctor may recommend a surgery called a vitrectomy. During a vitrectomy, the surgeon removes the blood-filled vitreous and replaces it with clear salt water, clearing the way for additional laser treatment. A vitrectomy is performed in the hospital or outpatient surgery center with anesthesia. The surgeon will use a special microscope to look into your eye, and will perform the procedure using microsurgical instruments.