Treating diabetic retinopathy: prevention and cure
At The Harley Street Eye Clinic, we always use the latest medicines and technologies available, creating a treatment plan tailored to your needs to help return your vision and the valuable independence that goes with it.
During the early stages of disease, we use injections and laser treatment to prevent the condition from progression, halting damage to the eye. We are also one of the few clinics to offer vitrectomy surgery before diabetic retinopathy has reached its most advanced stage, ensuring the best possible long-term solution and outcome for your vision. Suitability for vitrectomy surgery is decided in consultation with your ophthalmic surgeon.
Can progression of diabetic retinopathy be delayed?
It is vital to treat diabetic retinopathy in a timely manner. The sooner the condition is detected and treatment begins, the better the prognosis, and the less likely that more serious interventions will be necessary. By keeping your blood sugar in check, and your cholesterol and blood pressure low, you can prevent diabetic retinopathy from developing or keep it from progressing beyond the earliest, symptomless stage.
How is early (pre-advanced) diabetic retinopathy treated?
Once a scan of your retina reveals abnormal blood vessels that are likely to deprive your eye of oxygen, we will begin treatments to prevent disease progression and increase oxygenation. All three procedures that may be used: injections, laser treatment, or vitrectomy surgery, are carried out in hospital (The London Clinic).
For some patients with peripheral diabetic retinopathy, and patients with diabetic maculopathy, anti-VEGF (vascular epidermal growth factor) medications, such as Lucentus, Eylea, and Avastin, may be injected into the eye. These medications reduce blood vessel growth, and can prevent disease progression. The procedure involves administering eye drops as an anaesthetic, and injecting the medication directly into the eye. The whole procedure is quick, taking around 5 minutes, and most people experience minimal discomfort. Initially, three injections are given, at one-month intervals. Following this initial treatment, one of our ophthalmologists will assess how well your eyes are responding to the treatment, and decide whether this is a good option for you. The number of treatments required varies with each individual case, some patients only require very few extra injections, whereas other patients require more over a number of years.
Diabetic retinopathy can be treated with a type of laser therapy called photocoagulation. The purpose of this treatment is to stop further abnormal blood vessel growth, helping to rejuvenate the retina and increase oxygenation in the eye. As with injection treatment, eye drops will be used to anaesthetise the eye and widen the pupil. A special contact lens is used to hold your eyelid open and allows the laser beam to be focused onto your retina. The laser will be focused onto the areas of the retina where abnormal blood vessels are located, and will burn and finely cauterise these vessels, preventing further growth and bleeding. This is an outpatient procedure carried out in the laser suite of The London Clinic. It is generally painless, although some patients experience a sharp pricking sensation when certain areas of the retina are being treated. It takes around 10-20 minutes to perform the entire treatment.
Vitrectomy surgery – treatment for more advanced disease
Once diabetic retinopathy has progressed to an advanced stage, large amounts of blood may collect in the centre of your eye, obscuring your vision, or there may be extensive scar tissue that can cause retinal detachment. At this time, most centres turn to vitrectomy surgery. At The Harley Street Eye Clinic, we conduct vitrectomy surgery at this stage, but if possible we support earlier use of this procedure. If used earlier, vitrectomy has been shown to increase oxygenation of the retina, and improve prognosis. The procedure has radically improved over recent years. It has moved from a complex and invasive surgical procedure with a long recuperation period, to a quick and easy, stitch-free, keyhole procedure, with a rapid recovery. This is why, at The Harley Street Eye Clinic, we prefer to offer this form of treatment before diabetic retinopathy has progressed to the advanced stage.
How does vitrectomy surgery benefit the eye?
Within the eye cavity is a jelly-like fluid known as the vitreous humour. In a patient with diabetes this jelly accumulates chemicals that cause oxygen levels in the eye to drop and drive abnormal blood vessel growth. During vitrectomy surgery, the contaminated vitreous humour is removed from the eye and replaced with aqueous fluid. This removes the damaging chemicals, causing an improvement in the oxygenation of the retina and macula. The procedure also prevents the development of scar tissue in the vitreous, which can cause retinal detachment. The eye cannot regenerate vitreous humour naturally, but it will produce and regenerate aqueous fluid, which will remain in the eye indefinitely. For this reason, the procedure only needs to be carried out once.
What does vitrectomy surgery involve?
The surgical procedure is very quick, lasting only 30 to 45 minutes. It is usually conducted under local anaesthetic and sedation, so you will not experience any pain, and your awareness of what is happening is minimised. During the procedure, a tiny, keyhole incision is made to the eye, and the surgeon inserts small instruments into the eye to remove the vitreous gel. If necessary, the surgeon may also treat the eye with laser photocoagulation, remove fibrous or scar tissue from the retina, repair tears in the retina or macula, or flatten areas where the retina has become detached. Once this has been completed, the eye cavity will be filled with an aqueous fluid to replace the vitreous humour. Sometimes, instead of the aqueous fluid, a bubble of air, gas, or silicon oil may also be injected to help gently press the retina against the wall of the eye. In most cases of diabetic retinopathy, one eye is more affected than the other, and surgery only needs to be carried out on one eye. However, if both eyes require treatment, surgery on each eye must be carried out on separate occasions.
What will recovery from vitrectomy surgery involve?
Because of the tiny size of the incision used in the surgical procedure, no stiches are required, and an overnight hospital stay is unnecessary. After the procedure there may be some mild pain or discomfort but eye drops and a mild painkiller, such as paracetamol, will alleviate this. Any discomfort should subside very quickly. Most patients will notice their vision becoming sharper over time, and will experience a full recovery within 7-10 days. During this period, you may need to wear an eye patch at certain times of the day to allow your eye to rest and heal. One week after surgery you will attend a follow up appointment at the clinic, followed by another at three weeks. During these appointments one of our ophthalmologists with check that your eye is healing properly and your vision is improving.
As the surgical procedure often involves injecting a gas bubble into the eye, patients are advised not to fly until the doctor has confirmed that the gas bubble has dissipated. This may take several weeks. The caution is because the pressurisation inside the aircraft cabin could cause significant damage to the eye.
Risks associated with vitrectomy
Small gauge vitrectomy surgery carries a small risk of developing retinal detachment. This occurs in approximately 1 in 300 cases. At The Harley Street Eye Clinic, we take all possible precautions to reduce this risk by treating weak areas of the retina at the end of the procedure. We also use gas to reduce the risk even further. Infection is a risk associated with any eye surgery (1 in 3000 cases) and this is usually dependent on the hospital in which the surgery is carried out. However, modern day treatments together with antibiotics reduce this risk to a negligible level. Finally, patients who have not had cataract extraction prior to vitrectomy surgery, are very likely to develop a cataract within 2 years post-surgery. However, the first procedure of vitrectomy is the more significant surgery, after which the cataract surgery is a relatively minor undertaking a year or so later.
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