Retinopathy due to diabetes: treatment
Diabetic retinopathy: from mild damage to severe vision loss
Diabetic retinopathy can range from mild damage to the retina to severe vision loss or even complete blindness. Therefore, intensive and regular monitoring is essential. The first step in managing this condition is strict monitoring of your diet and blood sugar levels. If the retinopathy progresses further and is not controlled, additional treatments such as laser therapy or surgery may be necessary to prevent further damage and preserve vision.
The different treatment methods for diabetic retinopathy
1. Checkups and monitoring
Regular checkups and monitoring are essential for early detection and management of diabetic retinopathy, especially in the early stages. In nonproliferative diabetic retinopathy (NPDR), regular eye examinations, such as fundoscopy or OCT scans, can detect subtle changes in the retina before they become more severe.
In addition to eye exams, proper monitoring of blood sugar, blood pressure and cholesterol is crucial. Lowering blood sugar (HbA1c) can reduce the risk of complications by 40-60% and slow the progression of retinopathy. A combination of close monitoring and systemic control can reduce further damage and protect vision.
2. Macular focal laser treatment (photocoagulation).
Macular focal laser treatment, also known as photocoagulation, is a widely used technique for treating leaky blood vessels in diabetic macular edema. This condition, caused by fluid accumulation in the macula, can severely affect vision. Laser treatment targets the leaking blood vessels in the retina, seals them and reduces the accumulation of fluid. This helps prevent further damage and stabilizes vision.
The procedure is performed on an outpatient basis and takes less than 30 minutes. Using a special lens and a precise laser, the leaking areas in the macula are treated, while surrounding healthy retinal tissue is spared. The eye is numbed beforehand with eye drops to minimize discomfort.
Although macular laser treatment does not always fully restore vision, it can effectively prevent further deterioration and, in some cases, offer slight improvement. It is a proven, safe and effective method of managing complications of diabetic macular edema, especially when combined with strict control of underlying diabetes and other complementary therapies such as anti-VEGF injections.
3. Panretinal photocoagulation (PRP).
Panretinal photocoagulation (PRP) is a laser treatment used for proliferative diabetic retinopathy, a serious complication of diabetes in which abnormal blood vessels develop in the retina. These new blood vessels are fragile and can lead to bleeding or retinal detachment, resulting in potentially severe vision loss. PRP focuses on stopping the growth of these blood vessels and reducing complications.
During the procedure, hundreds of tiny laser dots are inserted into the peripheral parts of the retina. This helps improve oxygenation to the central parts of the retina and reduces pressure on the abnormal blood vessels. Treatment is performed on an outpatient basis, usually takes 20-40 minutes, and can be spread over several sessions if necessary. The eye is numbed beforehand with eye drops to minimize discomfort.
Although PRP can sometimes have side effects, such as a reduction in peripheral vision or night vision, it is an effective and proven method of maintaining central vision. It is an important treatment to prevent serious complications in diabetic retinopathy and significantly reduce the risk of permanent vision loss.
4. Intravitreal injections
Intravitreal injections are a common treatment for conditions such as diabetic macular edema and proliferative diabetic retinopathy. This involves injecting medication directly into the vitreous of the eye to reduce swelling, stop blood vessel leakage and prevent further damage to the retina. This technique focuses on treating the underlying causes of eye disease that affect vision.
The most commonly used medications are anti-VEGF injections, such as bevacizumab, aflibercept or ranibizumab. These drugs inhibit the growth of abnormal blood vessels and reduce swelling in the retina, which can improve vision and reduce complications. Corticosteroid therapy, such as dexamethasone implants, is used in some patients, especially if anti-VEGF medication is not sufficiently effective. These medications reduce inflammation and fluid accumulation in the retina.
Intravitreal injections are performed on an outpatient basis under local anesthesia and are safe and effective. Although multiple treatment sessions may be required, these injections offer a proven way to stabilize vision and prevent further deterioration.
5. Vitrectomy in diabetic retinopathy
A vitrectomy is a surgical procedure used for severe complications of diabetic retinopathy, such as vitreous hemorrhage or retinal detachment. During the procedure, the vitreous, the gel-like substance in the eye, is removed and replaced with a clear liquid or gas to restore vision and prevent further damage.
This procedure is particularly effective in proliferative diabetic retinopathy, where abnormal blood vessels have burst and blood has entered the vitreous. Removal of this blood improves vision clarity. A vitrectomy also provides the opportunity to remove scar tissue from the retina and reposition the retina if needed.
The procedure is performed under local or general anesthesia and usually takes 1 to 2 hours. Although recovery time may take several weeks, vitrectomy is a proven effective treatment to stabilize vision and prevent further complications in advanced diabetic retinopathy.
From 2010 to 2023, Dr. Pion was head of eye surgery at St. Peter's Hospital in Brussels. During these 13 years, he took on the most complex surgical cases and led a team of more than 20 surgeons.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Personalized advice from our experts
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
The course of a vitrectomy at Focus Eye Clinic
Step 1: Arrival and preparation at Focus Eye Clinic
Upon arrival at Focus Eye Clinic, you will receive a friendly welcome at the front desk, where our front desk assistants will register and prepare you for your surgery. Next, your pupil will be dilated (dilated) in preparation for the procedure. To make your experience as comfortable as possible, you will be given a relaxation pill. After all, surgery can be exciting, but our dedicated team of three nurses, two healthcare professionals, an anesthesiologist and Dr. Pion will guide you step by step.
Surgeries are always performed under local anesthesia, so you experience no pain and are completely at ease. This is always done under the supervision and guidance of our experienced anesthesiologist, who monitors your comfort and well-being throughout the procedure.
Step 2: Surgery of vitrectomy under local anesthesia (20 minutes - 1 hour)
The vitrectomy is performed under local anesthesia, so you will experience no pain and be completely at ease. The procedure itself takes an average of 20 minutes to 1 hour, depending on the complexity. During the surgery, the eye surgeon removes cloudy vitreous and replaces it with a clear liquid, which improves your vision.
Step 3: Get some rest before heading home
After the vitrectomy, you will be taken care of in our specially equipped relaxation area, where our dedicated nursing team will be there for you. Here you can rest peacefully and receive personalized care and attention. Our team will explain to you step-by-step instructions on postoperative treatment so that you are well prepared for your recovery at home. Once you are comfortable and have received all the information, you may safely leave for home. At Focus Eye Clinic, we strive to make your entire experience, from surgery to aftercare, as pleasant as possible.
How is a vitrectomy performed?
First step: inserting the trocards.
First, 3 separate openings will be made in the hard eye skirt (white sclera). The diameter of these openings is 0.57 mm. Three small tubes are placed in these openings through which the instruments enter the eye.
- At the first hole, the water drip will be placed.
- Through the second hole, the intraocular light will be inserted so that everything can be seen.
- Along the third hole, the vitrectome or intraocular forceps will be inserted into the eye.
Second step: removal of the vitreum
Through the vitrectome, the vitreum will be removed. The vitrectome is a small needle with a microscopic blade (guillotine) on the end. Small pieces of vitreum are aspirated into the vitrectome and cut off through the guillotine blade. Thus, the entire vitreum will be removed.
Third step: Manipulations on the retina
Depending on the condition, work will then be done on the retina. In a retinal detachment, the retina is brought back into place via special fluids. In membrane removals, a blue dye is introduced into the eye and then removed via ultra-fine tweezers. This stage is the most delicate step.
Fourth step: endolaser
To protect the retina from retinal detachment, an endolaser barrage will be performed at 360°. Studies have shown that this greatly reduces the risk of retinal detachment after vitrectomy.
Fifth step: insertion of the glass moisture substitute
Depending on your condition, the vitreous will be replaced with clear water, gas or silicone oil.
- If you eye is filled with gas, you will not see for 2 weeks. This gas may be necessary to keep your retina adjacent or to close a macular hole. However, it refers by itself. YOU MAY NOT TRAVEL BY AIRPLANE AS LONG AS THE GAS IS IN YOUR EYE.
- If your eye is filled with silicone oil you will have blurred vision. Silicone oil will be necessary if gas does not provide sufficient security of healing. Silicone will exert a stronger force on the retina to keep it in place. Silicone oil will always need to be removed with a new surgery.
Final step: closure of the eye
The final step is to close the eye by removing the
trocards. The openings are so small that they usually close by themselves. In
some cases, resorbable threads can be used. They
will disappear on their own after 4 to 6 weeks.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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At Focus Eye Clinic, we combine expertise and innovation with state-of-the-art equipment in ophthalmology aimed at treating a variety of eye conditions. With technologies such as the Ziemer Z8 Femtolaser and WaveLight® EX500 excimer laser, we perform refractive treatments (including Femto-LASIK, PRK and SMILE) with unparalleled precision.
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At Focus Eye Clinic, your care is paramount. Our team of nurses, optometrists and assistants work together with one goal: improving your vision. From your first moment of contact to your final checkup, we will guide you with a personalized and caring approach.
A multidisciplinary team for your treatment:
Our experienced multidisciplinary team offers a wide range of ophthalmic treatments. After an initial diagnosis, we refer you to the doctor who best suits your specific needs, ensuring you receive the highest quality of care.
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Throughout the entire procedure, a permanent assistant is available to you. She knows your file inside out and ensures that all your questions are answered quickly and clearly. If necessary, she will put you in direct contact with the right doctor.
Fast and efficient follow-up
We strive to offer you an appointment within two weeks and plan with you the most convenient time. This efficient system ensures a smooth and personalized experience, allowing you to concentrate fully on your treatment.
A luxurious and comfortable setting at Focus Eye Clinic
At Focus Eye Clinic, we believe that medical treatment should be not only effective, but also comfortable and soothing. Therefore, we have designed our clinic with an eye for luxury and comfort, so that you feel completely at ease from the very first moment.
Our modern and stylish spaces exude calm and confidence, and are designed to provide you with a relaxing experience. From the warm welcome at reception to the comfortable waiting areas and state-of-the-art treatment rooms, every detail has been carefully chosen with your well-being in mind.
At Focus Eye Clinic, we combine advanced technology with luxurious surroundings, so you can enjoy the highest quality care in a setting that exudes peace and confidence. Your health and comfort are our priority, and you will notice that with every visit.
