In the early stages of DR, treatment within the eye is not required, and cases can be observed safely with close monitoring, and control of the blood glucose level to prevent DR from worsening.
In more severe cases where PDR has developed, or if there is a high risk of PDR, your ophthalmologist may recommend a laser treatment to reduce the risk of complications and vision loss. This laser treatment, called panretinal photocoagulation (PRP) is used to treat the peripheral retina, so as to prevent or stop the growth of the abnormal new blood vessels, and reduce the risk of severe vision loss.
In general, each eye may require two to three sessions for PRP to be completed. You will be expected to go for regular treatments over a period of six to twelve months before diabetic retinopathy is controlled adequately. In some patients with PDR, an alternative treatment may be with regular injections of medications into the eye, called intravitreal injections with anti-VEGF (anti-vascular endothelial growth factor) medications. If this is an option, your ophthalmologist will discuss the pros and cons of the different treatment options with you.
In patients with loss of central vision due to DME, the treatment options also include laser treatment, or intravitreal injections of anti-VEGF medication. Bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (Eylea) are some medications that are frequently used to treat DME and DR. Other new medications are also in development, and may be available soon. These treatments can reduce the macular swelling and improve vision.
Often, multiple injections at intervals of one month or longer are required to resolve the swelling. Repeated injections at longer intervals may also be required to maintain the visual improvement.
In cases of severe PDR causing massive bleeding in the eye, or retinal detachment, then surgery may be required. Surgery for PDR involves a vitrectomy, a form of "keyhole" surgery that uses small instruments to enter the eye to remove the vitreous gel and blood within the eye. If necessary, scar tissue causing retinal detachment can also be peeled off and removed during surgery. A gas bubble or silicone oil may be injected into the eye at the end of surgery, to maximise the chances of success. In severe cases of PDR, recovery of vision may be limited, even with successful surgery.
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