Non-Proliferative Diabetic Retinopathy

Introduction

Patients with diabetes mellitus can develop serious ocular complications that can affect their vision. Over time, high blood sugar leads to damage to the retinal blood vessels. Several complications may develop, including macular edema (swelling in the central retina) and retinal ischemia (poor blood flow). Other findings in nonproliferative diabetic retinopathy include retinal hemorrhages and cotton wool spots (small white spots in the retina that form because of poor blood flow).

Management

Medical control of diabetes mellitus is very important in order to preserve vision as well as to prevent other systemic complications such as kidney disease, heart disease, stroke, and neuropathy. It is important to have regular eye examinations because many changes from diabetic retinopathy may be present even if a patient is asymptomatic.

Diabetic macular edema is a common cause of central vision loss. Laser therapy is often used in order to decease the risk of future vision loss. Laser is applied to leaking blood vessels (microaneurysms) as well as other areas where the retina is swollen. Other management options include ocular injections with bevacizumab (Avastin) or steroids. Surgical treatment for diabetic macular edema is used, albeit rarely. Sometimes the vitreous gel is firmly adherent to the retina, and pulling from the vitreous may prevent the retinal swelling from resolving despite other treatments. Vitrectomy surgery can be helpful in this setting.

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