hemorrhagic retinopathy
March 27, 2017 | 20,00 EUR | answered by Nadja Struß
Hello,
I have been suffering from type 1 diabetes for 38 years. I have had recurrent hemorrhages from the old vessels that then go into the vitreous body and reduce my vision to as low as 0.2%. I am 40 years old and want to postpone the surgery for as long as possible. My doctor also shares this opinion. He checks me every 4-6 weeks, but it still happens - last bleeding was 3 years ago. Resorption and back to 100% after 6 months. Now, 3.5 years later, I have had two bleeds within 4 weeks. First a little, then at 60%, and then after a visit to the doctor, no new bleeding but a decrease in vision from 60% in the morning to 20-30% in the evening. The doctor advises to wait for resorption. It should improve in 6-8 weeks if it is a minor bleed. Are there any drops or medications that can speed up the process? Is eye lymphatic drainage indicated or harmful? A physiotherapist recommended it to me. I am planning to fly to Spain with my family in 3 weeks. Do you think it is safe? I would like to have your opinion as a second opinion. My doctor says it's not a big deal, but I am going crazy! I am already avoiding sports for fear of new bleeding! Please respond. Thank you very much!
Dear questioner,
From your descriptions, I infer that you have a condition known as proliferative diabetic retinopathy. This condition occurs as part of diabetic microangiopathy, which involves damage to small and smallest blood vessels.
In the eye, this can lead to the vessels of the retina uncontrollably "proliferating", which is known as neovascularization.
To reduce this neovascularization, there are two primary therapeutic approaches:
1. Laser coagulation, where laser radiation is used to destroy the proliferating lesions in the retina
2. Injection of medications into the vitreous humor with a syringe, which needs to be repeated regularly. Medications are available that inhibit vessel growth, known as VEGF antibodies.
However, only your local ophthalmologist can determine if these measures are appropriate and necessary for you. Perhaps you have already discussed these treatment options. The decision to undergo these measures should be carefully considered, as they are not without risks and may sometimes lead to worsening of vision.
As I understand it, you have so far only experienced bleeding in the vitreous humor - sometimes followed by scarring of the vitreous humor as a complication. When the vitreous humor scars, it contracts and exerts traction on the retina, which can lead to partial detachment and severe vision loss. This is called tractional retinal detachment. Vitrectomy is recommended in cases of tractional retinal detachment, as it prevents significant damage to the retina. Additionally, vitrectomy may be indicated in cases of vessel ingrowth into the iris and increased intraocular pressure.
If there have only been bleedings without scarring, which resolve on their own, one should be cautious with vitrectomy, as your ophthalmologist has also mentioned. Unfortunately, there is currently no effective way to accelerate the absorption of blood, as this is still under research. Eye drops do not reach the interior of the vitreous humor, so injecting medication requires a syringe.
It is crucial that you see your ophthalmologist for every bleeding, as they need to determine if the retina has detached or not.
The blood in the vitreous humor settles according to gravity. If the ophthalmologist confirms that the retina is attached, you can resume your activities (including sports) normally. It is advisable to sleep with a slightly elevated upper body, as otherwise the blood will flow directly in front of the functional part of the retina during the night, causing worse vision in the morning. With a slightly elevated upper body, the blood settles at the base of the vitreous humor, allowing light to pass through more easily.
The effectiveness of eye lymphatic drainage is not scientifically proven. I am not sure how this would work, as there is no lymph fluid in the eye and therefore no drainage pathways. This measure is more suitable for swollen eyelids.
I hope this information has been helpful to you.
If you would like to further inform yourself, I recommend the patient guideline "Diabetes - Damage to the Retina: Prevent and Treat" from the Association of the Scientific Medical Societies (AWMF):
http://www.awmf.org/uploads/tx_szleitlinien/nvl-001bp_S3_Netzhautkomplikationen_Typ-2-Diabetes_2016-08.pdf
Additionally, for questions regarding the latest research, you can consult the outpatient eye clinics at university hospitals.
If you have any further questions, please feel free to write to me.
Kind regards,
Nadja Struß
