La Retinopatía Diabética es una Complicación Frecuente en la Diabetes
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Diabetic Retinopathy

The effect of diabetes on the eye is called diabetic retinopathy. Diabetic retinopathy is the first cause of blindness in the USA. It is estimated that 35% of diabetics have some form of diabetic retinopathy and that only 10% of diabetics never have retinopathy in their lifetime.
Diabetes is a disease that occurs when the pancreas does not secrete enough insulin, or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults.  

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How does diabetes affect the retina?

Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s affect on the retina is the main threat to vision.  Most patients develop diabetic changes in the retina after approximately 20 years. 
Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy. In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision. The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New fragile vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina, called neovascularization.  Unfortunately, these delicate vessels hemorrhage easily.  Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.   In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retina detachment and glaucoma.

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Symptoms

The affect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Some common symptoms of diabetic retinopathy are:

•Blurred vision (this is often linked to blood sugar levels)
•Floaters and flashes
•Sudden loss of vision

Detection and diagnosis

Diabetic patients require routine eye examinations so that related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who works closely with the ophthalmologist.
The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with an ophthalmoscope. Fluorescein angiography and optical coherence tomography (OCT) are routinely used in the evaluation of diabetic retinopathy. Most patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease. 

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Treatment

Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. These include fluorescein angiography, retinal photography, and ultrasound imaging of the eye.


The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems treated by vitreo-retinal surgeons.  Laser surgery called pan retinal photocoagulation (PRP) is usually the treatment of choice for this problem.

With PRP, the surgeon uses a laser to destroy oxygen-deprived retinal tissue outside of the patient’s central vision. While this creates blind spots in the peripheral vision, PRP prevents the continued growth of the fragile vessels and seals the leaking ones. The goal of the treatment is to arrest the progression of the disease.

Vitrectomy is another surgery commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous fluid from the eye, and replaces it with clear salt solution (saline). At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal detachment or tears.

Patients with diabetes are at greater risk of developing retinal tears and detachment. Tears are often sealed with laser surgery. Retinal detachment requires surgical treatment to reattach the retina to the back of the eye. The prognosis for visual recovery is dependent on the severity of the detachment.

Prevention

Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes. 

Diabetics can greatly reduce the possibility of eye complications by scheduling routine examinations with an ophthalmologist.  Many vision problems can be treated with much greater success when caught early.

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Retinopatía Diabética

La retinopatía diabética es la primera causa de ceguera en U.S.A. El 25% de diabéticos tienen alguna forma de retinopatía diabética y solo un 10% no presentan la retinopatía durante su vida.

Por que se produce la retinopatía diabética?

Al tener niveles altos de azúcar (glucosa) en la sangre, como los generados por la diabetes, se produce un daño del endotelio (parte importante de la pared de los vasos sanguíneos) que afecta la totalidad del sistema circulatorio del cuerpo, incluyendo los vasos sanguíneos de la retina en el ojo.

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¿Como se produce la retinopatía diabética?

La retina es la parte del ojo más importante para la visión. Es allí donde la luz se convierte en impulsos eléctricos para que las imágenes sean interpretadas por el cerebro. La diabetes puede llevar a un mal funcionamiento de la retina de tres formas principales:

Edema Macular: Acumulación anormal de líquido en las finas capas de la retina (en la mácula, el sitio de mayor sensibilidad de la retina). El engrosamiento de la mácula impide su función adecuada. El líquido proviene de los vasos sanguíneos cuyas paredes tienen una función inadecuada debido a la diabetes.

Hemorragia Vítrea: En fases más avanzadas de la retinopatía se forman dentro del ojo nuevos vasos sanguíneos (neovasos) que se rompen con gran facilidad. Al romperse liberan sangre dentro del ojo, lo que impide el paso de la luz hacia la retina.

Desprendimiento de Retina: También en fases avanzadas de la enfermedad, se puede desprender la retina, principalmente por tracción ejercida por el vítreo y los neovasos. Al desprenderse la retina, pierde su fuente de nutrientes y por lo tanto su función.

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¿Que sintomas ocasiona la retinopatía diabética?

Los primeros síntomas que se presentan con la retinopatía diabética son:

  • Disminución de la visión nocturna.

  • Pobre recuperación de visión posterior a exposición a luz brillante.

  • Alteraciones en la visión de colores (principalmente azul y amarillo).


Es importante anotar que para que aparezcan síntomas la enfermedad debe estar en fases avanzadas donde el tratamiento no es tan efectivo. Es por eso mejor controlar la retinopatía antes de que aparezcan los síntomas.

¿Como se diagnostica?

El diagnostico de la diabetes se realiza mediante un examen oftalmológico cuidadoso y con la ayuda de exámenes diagnósticos como la angiografía con fluoresceína y la tomografía óptica coherente (OCT). Con estos exámenes podemos detectar la extensión de la enfermedad y determinar el tratamiento mas efectivo.

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¿Como se trata?

Cuando hay hemorragias e inflamación en la retina debido a la diabetes es importante tratarlo cuanto antes para evitar que la enfermedad progrese y dañe permanentemente los ojos. En un principio el tratamiento de la diabetes es con rayo láser para disminuir los sangrados e inflamación. Cuando la enfermedad esta muy avanzada puede ser necesaria la cirugía de retina para lograr controlar las complicaciones relacionadas con la retinopatía diabética. La cirugía de retina es llamada vitrectomia.

La vitrectomia es realizada frecuentemente en pacientes diabéticos que sufren de hemorragia vítrea. Durante la vitrectomia, el cirujano de retina remueve el sangrado y re-emplaza la gelatina del ojo (llamado vitreo) con solución salina. Al mismo tiempo, el cirujano extirpa el tejido fibrotico que ocasiona tracciones sobre la retina y repara los desgarros de retina y/o el desprendimiento de retina. El pronostico visual dependerá de la severidad del problema.

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