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The only treatment currently available for diabetic retinopathy
is laser photocoagulation.
Although laser photocoagulation is a destructive treatment
which results in some vision loss, developments in the technique
now mean that total blindness can be prevented in most cases.
Laser photocoagulation is recommended for the treatment of
high-risk proliferative diabetic retinopathy and clinically
significant macular oedema.
In some cases it should be considered for the treatment of
severe non-proliferative diabetic retinopathy in the absence
of macular oedema.
Types of laser
photocoagulation:
Panretinal photocoagulation is used to treat proliferative
diabetic retinopathy.
The laser is applied to the entire lesion with the exception
of the macula and the papillomacular bundle. The aim is to
reduce the amount of neovascularisation.
Panretinal photocoagulation is usually administered over
two to four sessions, with 2 weeks in-between each session.
Each burn is about 500 µm in diameter.
Focal photocoagulation
Focal laser photocoagulation is used to treat exudative
macular oedema, where leaking capillaries, visible on fluorescein
angiograms, can be targeted precisely.
The burns are usually 50-100 µm in diameter.
Treatment seals the leaking vessels and allows fluid and
hard exudates, which distort vision, to be absorbed.
Grid photocoagulation
Diffuse macular edema is treated with grid photocoagulation.
This involves applying about 100-200 burns, each with a diameter
of between 100 and 200 µm, in one session (although
only one eye should be treated at a time).
The treatment prevents leakage from the capillaries as well
as indirectly affecting their integrity, and that of the retinal
pigment epithelium (RPE), resulting in the clearing of macular
oedema and hard exudates.
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