Diabetic Retinopathy

Diabetic retinopathy is currently one of the leading causes of blindness worldwide. Given the importance of this issue, in 2010, under the leadership of Professor A.H. Vardanyan, Head of the Vitreoretinal Department at the S.V. Malayan Ophthalmological Center, a committee was established to address diabetic eye complications. A dedicated examination room for diabetic patients was also set up.

Vascular complications in the retina caused by diabetes, known as diabetic retinopathy, are classified into non-proliferative and proliferative forms. The condition affects approximately 25% of patients with both insulin-dependent and non-insulin-dependent diabetes.

Patients commonly report blurred vision, distorted images, decreased night vision, floating spots, and diminished color perception.

Symptoms of Non-Proliferative Diabetic Retinopathy include microaneurysms, dilated capillaries, dot and blot hemorrhages, hard exudates in the nerve fiber layer, and clinically significant macular edema.

Treatment involves panretinal laser photocoagulation under local anesthesia in 2 or 3 sessions, along with intravitreal injections of Avastin (Bevacizumab).

Symptoms of Proliferative Diabetic Retinopathy include neovascularization on the optic disc or elsewhere in the retina, preretinal or vitreous hemorrhages, preretinal fibrosis, and tractional retinal detachment. Surgical treatment includes posterior closed vitrectomy using 20G, 23G, and the most advanced 25G and 27G instruments. Temporary vitreous substitutes such as silicone oil, C3F8 gas, balanced saline solution, sterile air, or heavy liquids are used as needed.

Early treatment enables better control of the disease. Proper treatment of diabetic retinopathy often leads to long-term stabilization. Laser photocoagulation improves vision in 17% of cases. Proper control of blood glucose and blood pressure slows the progression of diabetic retinopathy and macular edema in patients with both type I and type II diabetes.

Early diagnosis and appropriate treatment can prevent further complications.

Retinal Detachment

Patients with retinal detachment who visit the Trauma Department at the S.V. Malayan Ophthalmological Center can receive high-quality, modern care.

Retinal detachment is the separation of the sensory retina from the pigment epithelium due to fluid accumulation between the layers. Retinal detachment often leads to severe vision loss or blindness and therefore requires immediate medical intervention to restore the anatomical structure of the retina and minimize loss of photoreceptor cells.

Based on its cause, retinal detachment is classified into three types: rhegmatogenous, tractional, and exudative.

Rhegmatogenous Detachment occurs due to tears in the retina, allowing liquefied vitreous fluid to pass underneath and cause local, then widespread separation.

Typical symptoms include photopsia (flashes of light) and floaters in the vitreous. These appear during acute posterior vitreous detachment caused by traction on areas of vitreoretinal adhesion. When these adhesions break, they may tear the attached section of the retina. Over time, patients may notice progressive visual field defects, possibly affecting central vision. Patients often describe these changes as a sensation of a "dark curtain."

Tractional Detachment is typically associated with proliferative diabetic retinopathy, retinopathy of prematurity, proliferative vitreoretinopathy, or penetrating trauma. It results from preretinal fibrosis and mechanical contraction. Photopsia is usually absent because the detachment develops gradually from hidden vitreoretinal traction without acute posterior vitreous detachment. Visual field loss also progresses slowly and may take months or even years.

Exudative Detachment is usually due to intraocular inflammation or tumors, resulting in subretinal fluid accumulation without retinal tears or traction. In such cases, the detached retina is highly mobile, and a “shifting fluid” phenomenon may be observed.

Treatment of retinal detachment requires urgent surgery aimed at identifying and sealing retinal tears, removing preretinal and vitreoretinal tractions, and treating any underlying disease.

Surgical Methods:

Pneumatic Retinopexy – a minimally invasive outpatient procedure where an expanding inert gas is injected intravitreally to seal the retinal tear. The tear is then treated with cryocoagulation or laser photocoagulation, either before or several hours after the gas injection. After surgery, the patient must maintain a specific head position for a few days so that the gas bubble remains in contact with the tear. This procedure is only suitable for recent detachments with breaks located between 8 and 4 o’clock.

Scleral Buckling with an Explant (local or circular): This involves indentation of the sclera. The goal is to close retinal breaks by bringing the pigment epithelium and sensory retina together and reducing dynamic vitreoretinal traction. The explant, typically made of silicone, is sutured to the sclera and comes in various shapes and sizes, including silicone bands and sponges. Scleral buckling can be combined with cryocoagulation, laser photocoagulation, and posterior closed vitrectomy.

Posterior Closed Vitrectomy – performed for persistent vitreous hemorrhage, tractional angioretinopathies, macular tractional edema, and tractional or rhegmatogenous retinal detachments. If needed, retinal endolaser photocoagulation is performed during surgery. After vitrectomy, temporary vitreous substitutes such as filtered air, inert gases, or silicone oil are used for internal tamponade. Following the injection of air or gas, the patient may only perceive light for several days.

As the gas is absorbed, a boundary forms between the gas bubble and intraocular fluid. Patients often report seeing the bubble move with head movements. Gradually, vision returns. Silicone oil is used for longer-term intraocular tamponade.

Subretinal Fluid Drainage

If left untreated, retinal detachment can lead to irreversible vision loss, including the complete loss of the eye.