Medical Treatment of Retinopathy of Type-2 Diabetes

Abstract

The medical treatment of retinopathy in type-2 diabetes should be considered as a major component in the overall management of diabetic retinal disease. It is clear that specific and timely interventions, such as glycemic and blood pressure control, are the basis for good management of diabetic retinopathy. The American Diabetes Association has developed specific recommendations concerning diabetic retinopathy for the primary care physician and diabetologist. The ophthalmologist must be aware of these recommendations and establish efficient communication channels with the colleagues who follow their patients and the progression of diabetes closely. The challenge for the ophthalmologist is to make sure that, when signs of retinopathy are detected, information regarding the status of the retina, prognostic factors and the rate of progression must be given to the primary care physician and diabetologist. Under these circumstances, excellent glycemic control, aggressive management of blood pressure and normalization of lipids are all needed, and the goals to be achieved must be shared between the ophthalmologist and the primary care physician or diabetologist. Appropriate medical management of diabetic retinopathy is fundamental to reduce the risk of blindness. This goal can only be achieved if the ophthalmologist is fully aware of the role of medical management and establishes an efficient flow of communication with the primary care physician or diabetologist, particularly for the diabetic patients whose eyes show signs of risk for rapid progression of their retinopathy.

Diabetic vitrectomy: risks, prognosis, future trends

“…Future therapy will likely involve an associative cocktail of drugs that will act at all three levels. These, coupled with good blood pressure and serum lipid control, complete the current thought with regard to diabetic pharmacotherapy [9,[12][13][14][15].…”

“…Furthermore, postoperative intraocular inflammation, worsening diabetic macular edema (DME), and fibrovascular proliferation may all someday be prevented by systemic and intravitreal pharmacotherapy [8,9]. It was suggested in a recent review [9] that medial therapy be targeted at three levels in controlling diabetic retinopathy. The first level is in quickly re-establishing euglycemia as soon as diabetes mellitus is diagnosed.…”

Current management of diabetic tractional retinal detachments

“…Optimal control of systemic conditions helps patients get medically cleared for surgery and may decrease the risk of post-operative complications, but unfortunately these interventions will not reverse the damage already present in most eyes with TRDs or change their need for surgery. [ 41 ]…”

Spontaneous Resolution of Tractional Retinal Detachment in a Type II Diabetic Patient

“…The incidence of severe visual loss decreases by about 50% when the retina PRP is performed before developing severe PDR‑related complications such as TRD and vitreous hemorrhage [ 19 ]. However, TRD involving or threatening the macula is a classic indication of vitrectomy, and a non-surgical approach is unlikely to resolve a TRD [ 20 ]. In our case, tractional detachment spontaneously resolved without surgical intervention, and vision returned to 20/20, which is unusual.…”