Anti-VEGF Therapy

Anti-VEGF therapy counteracts the excessive amount of VEGF (vascular endothelial growth factor) that is in the retinal tissues. At the present time, this medication (Avastin, Lucentis. or Ilyea) needs to be administered directly into the vitreous cavity of the eye in order for it to reach high enough concentrations in the retina to block the dangerous VEGF.

Using sterile technique and specialized needles, an injection is made through the white portion of the eye (sclera) into the gel. Although it sounds discomfiting, after the first one or two injections the anxiety level abates. There is some pain associated with the injection, lasting about a second as the needle penetrates through the sclera.

In diabetes sometimes more than one injection will be needed depending upon the stage of the disease.

Anti-VEGF therapy is used to treat both background and proliferative retinopathy as well as retinal vascular occlusions.

Laser surgery

Laser surgery is often recommended for people with macular edema (background diabetic retinopathy) or proliferative diabetic retinopathy (PDR).

Laser treatment had been a first line therapy for backround disease, now however it is usually used as second line treatment after anti-VEGF injections have been given.

• For macular edema, the laser is focused on the damaged retina near the macula to decrease fluid leakage. The laser treats areas where the capillary beds or micro-aneurysms are leaking fluid and seals them off.
• For PDR, the laser is focused on all parts of the retina except the macula. This pan-retinal photocoagulation (PRP) treatment causes abnormal new vessels to shrink and often prevents them from growing. It can decrease the chance that vitreous bleeding or retinal distortion will occur. Multiple laser treatments over time are sometimes necessary. An anti-VEGF injection sometimes is administered two weeks prior to the PRP to decrease the risk of macular edema.

Vitrectomy

• For PDR or non-clearing vitreous hemorrhage, the ophthalmologist may recommend a vitrectomy. During this microsurgical procedure, performed in the operating room, the vitreous is removed and replaced with a clear solution. Any membranes pulling or detaching the retinal can be peeled off as well. Additional laser treatment can be given at the time of the surgery. It is considered a major ophthalmic surgery often requiring general anesthesia and months to recover fully. Cataract formation several years after vitrectomy frequently occurs.
• Vitrectomy often prevents further bleeding by removing the abnormal vessels that caused bleeding. If the retina is detached, it can be repaired during the vitrectomy surgery. Surgery should usually be done early because macular distortion or traction retinal detachment will cause permanent vision loss. The longer the macula distorted or out of place, the more serious the vision loss will be.

Management

People with diabetes should be seen once a year unless told otherwise. More frequent medical eye examinations may be necessary after a diagnosis of diabetic retinopathy is made.

You should have your eyes checked promptly if you have visual changes that:

• Affect one eye only
• Last more than a few days
• Are not associated with a change in blood sugar.