How does diabetes come? Whenever you take blood vessel to imagine it to be a PVC tube and let a large quantity of fluid with glucose content in it, then the walls of that tube will get weak. Wherever the walls get weak, we call it as a microanuerysm. When there is even more flow and for a longer duration, this dilation will rupture. If this becomes too thin, it will leak more blood. If it leaks blood, we have now a retinal hemorrhage. This retinal hemorrhage will absorb. When it absorbs, it absorbs with some amount of cotton wool spots that we call, but you can imagine it to be a certain amount of scar. Till here, we are looking at a non-proliferative diabetic retinopathy. The treatment of choice would be the laser treatment upon the retina. What I would like to do is low threshold laser. So we should not even see or feel the amount of laser that is being done. Don’t like to cross more than a 150 counts, less than 50 millijoules. So I would not like to put so much of energy in one shot. We would like to spread it over 3 -4 subsequent days. We move onto much, more serious condition called as proliferative diabetic retinopathy. So now it is not staying eithing the retinal layer. So now it is not staying within the retinal layers, it is moved out. There is huge vitreous hemorrhage, there is sudden loss of vision. Once again this hemorrhage is going to heal with scar. This scar is going to pull up the retina. When it pulls up the retina, we have the tractional retinal detachment. Certain areas on the retina has gone dead or ischemic. This will further lead to fresh blood vessels coming. This is called as neovascular and since this increases the pressure inside the eye, it is called as neovascular glaucoma. This is proliferative diabetic retinopathy. Usually when it comes to one eye, it takes the other eye too. Within 5 years, with untreated condition, the person goes blind. So how do we treat this? We need to give laser treatment. Along with that, the DNA gene therapy, that is the, autologous booster injection. What we do here is take one drop of the patients own blood, make that patients own fetal healthy DNA and that patients own stem cells and that way we inject it into the eye and that way we treat the eye. Most of these conditions need a surgical exercise. If there is a vitreous hemorrhage, in the eye, we need to remove that vitreous hemorrhage. After is a tractional detachment in the eye, we need to redress that. If there is neovascular glaucoma, we have to make sure that the pressure of the eye coms down. Some of useful vision does remain with doing any of the surgical exercise.

свернуть