The most advanced treatments (lasers, drugs and surgery) can reduce the proliferation of the vessels at the origin of the major problems with the nerve membrane of the eye
A fundamental reason why it Diabetic retinopathy screening is helpful and sacrosanct is that they exist effective therapies to manage it. Today it is possible to save the sight, if the diagnosis arrives in time and treatment is made: as underlined by Stela Vujosevic, head of the Retina Medica Service of the MultiMedica Group of Milan, “where diabetic retinopathy screening existsas in the United Kingdom or in some Northern European countries, lThe prevalence and incidence of the disease has decreased and diabetic retinopathy is no longer the leading cause of blindness in the working-age population“. Given that the best strategy remains prevention, trying to keep blood sugar stable and checking the condition of the retina at regular intervals, which what can be done when the disease occurs?
Photocoagulation
“Today the possibilities are different. It is still in use and very useful for example the laser photocoagulation, which until twenty years ago was the only possibility of intervention », replies Vujosevich. “The laser is used to prevent blood vessels in the retina from bleeding, reducing vision, and also to reduce the retina’s need for oxygen, which triggers the production of abnormal blood vessels which then impair vision. The laser can Like this slow down the loss of vision and today there are also “mild” ones, suitable for treating the central part of the retina in case of edema, that is when liquid leaking from the vessels themselves is collected:
until recently it was possible to intervene with photocoagulation only in the peripheral areas, today even the central one can be treated with “light” lasers, although this option is not the first choice
“.
The laser, by eliminating the areas of retinal tissue that is sick and suffering from lack of oxygen, prevents the signals from starting to form new blood vessels and the retinopathy to progress.
Antibodies
However, today it is also possible to intervene with specific drugs which prevent abnormal blood vessel proliferation. “It’s about the anti-VEGF monoclonal antibodies (Vascular Endothelial Growth Factor, i.e. the vascular growth factor that is directly responsible for stimulating the formation of new vessels, ed), already used also for macular degeneration linked to aging », observes Vujosevic. «They are the drugsn use for years, safe and well known, which may be helpful in some cases of proliferative diabetic retinopathy and when there is a macular edema, because they reduce the growth and permeability of the retinal vessels. These drugs come injected into the ocular vitreous, in sterile clinics or surgical rooms so in total safety
; the injections must be repeated according to cycles that foresee precise timing, but the results are very good and in some cases it is also possible to have a visual improvement. Furthermore, diabetic retinopathy is a complex pathology in which the levels of various inflammatory molecules also increase: for this reason in some patients it is necessary to use
broad spectrum steroidal anti-inflammatory drugs“.
Vitrectomy
In severe casesqhen the disease progresses and there is heavy bleeding or edema that makes the vitreous opaquethe
vitrectomy, which is the surgery to remove the vitreous body inside the eye. Finally, in some patients, diabetic retinopathy can cause a detachment of the retina on which it is possible to intervene with the laserwhich creates a kind of scar to weld the degenerated tissue to prevent the lesion from widening, oror with a proper microsurgery to repair the retina or make it reattach.
Future therapies
In the future, it may be possible to intervene with even earlier therapies for diabetic retinopathy, to prevent its progression: studies conducted on mice promise and published onAmerican Journal of Pathology, according to which the key is to act on local inflammation due to hyperglycemia. “Inflammation causes nerve degeneration and microvascular abnormalities, but damage to the nerve precedes more visible damage to blood vessels,” explains Hyung Jin Choi of the University of Seoul in South Korea, author of the investigations. “Therefore, a therapy with an anti-inflammatory and neuroprotective effect could be a successful strategy in the period between the diagnosis of type 2 diabetes and the clinical onset of retinopathy.”
Contact lenses with LED light
Choi focused on a GLP-1 receptor agonist already used for diabetes therapy: the drug demonstrated a neuroprotective and anti-inflammatory effect independent of the action on glycemia, because the insulin-treated mice were not equally protected from retinal damage. “The cells of the retina begin to die long before there are the microscopic hemorrhages typical of diabetic retinopathy: protecting them, reducing neuroinflammation, can be a winning strategy»Says Choi. Something similar could happen with the contact lenses with LED light developed by researchers from the South Korean University of Pohang: the lenses, designed for patients with early stage retinopathy, they emit a weak infrared light that appears to be protective for the retina. “The mice who wore lenses for 15 minutes three times a week for two months did not develop the disease like those to which they have not been applied ”, conclude the authors.
November 14, 2022 (change November 14, 2022 | 10:51)
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