INTRAVITREAL ANTIVEGF/OZURDEX INJECTIONS
MICROPULSE LASER PHOTOCOAGULATION
PRP GROWTH FACTOR INJECTIONS
MAGNOVISION THERAPY

The eyeball consists of refractive settings that focus light on the retina from front to back. The cornea at the front and the lens behind it allow the light to be focused on the macula (yellow dot), the area of the retina that provides sharp vision.

The eyeball consists of 3 layers from the inside out: the retina is the innermost, the vascular layer is in the middle, and the sclera, which gives the eyeball its rigidity, is the outermost.

Visions of the object start with the focusing of light coming from the objects on the macula (yellow dot). There are cells in the retina that convert light energy into electrical energy and transmit it to the brain.

The retina consists of millions of nerve cells. There is a widespread vascular network that feeds and oxygenates these cells.

Diabetes mellitus deteriorates the structure of small vessels over the years and causes occlusion of these vessels.

Retina veins in the eyes, glomerulus veins in the kidneys, and foot veins are the most rapidly occluded vessels. If diabetes is not kept under control within 5 years, it can cause retinal hemorrhages and blindness, kidney failure and dialysis dependence, non-healing scars on feet, and gangrene.

Good metabolic control is achieved by keeping not only glucose but also hypertension and blood fats/cholesterol under control. Control of these blood values together minimizes the risk of occlusion in the eye vessels.

Even if blood sugar is well controlled, it is very important for those with diabetes mellitus for more than 10 years to have an eye ground check at least every 6 months, even if they have no complaints.

As diabetes progresses and is not kept under control, respectively:

• Deterioration of the capillary vessels in the retina,
• Bubbling called microaneursym,
• Serum and fat effusions called hard exudate,
• Bleeding into the retina,
• Edema in macula i.e. yellow dot and decrease in vision,
• New vein formations susceptible to bleeding,
• Bleeding of newly formed vessels, forming bands/membranes in the eye, causing retractions and tears in the retina.

as a result of all these processes, permanent decrease in vision or blindness occurs!!!

The visual quality of the patient decreases very much due to bleeding and effusion from retinal vessels.  Patchy images occur due to bleeding and effusions. If there are both bleeding and macular edema, refraction and patchy images occur in the objects looked. Sometimes macular edema occurs by itself without bleeding, objects may appear refracted/distorted or big-small.

Handling and treatment:

• Ensuring good metabolic control
• Adjusting of medication or insulin doses by follow-up of the patient by the internal medicine or endocrinology specialist; investigation of anemia and sleep apnea syndrome,
• Keeping hypertension and blood fats/cholesterol under control,
• Special follow-up of adolescent and pregnant diabetics,
• Arrangement of daily-weekly-monthly diet list by dietitians
• Referring smokers to smoking cessation clinics and
• Abstinence from alcohol
• Walking 30 minutes a day

Without achieving a good metabolic control, efforts of the ophtalmologists will be futile!!!

In early stages that don't impair vision, eye ground check and necessary retina imaging analyses are performed every 3-4 months. If the nutrition of the retina is not impaired during the microbleeding and leakage stage, growth factor injections can be made outside the eye (prp) and can be applied together with magnovision if necessary.

If macular edema has developed or is at a level that threatens vision, micropulse laser that is not sensible is applied to the retinal areas with impaired nutrition; Anti-VEGF or long/slow release steroid injections are administered intraocularly to resolve macular edema. The micropulse laser provides the secretion of growth factors from the tissues, which are necessary to repair the retina and strengthen the retinal vessels.

If new vessel formations suitable for proliferative bleeding have developed, this stage is the most critical stage that can cause the development of blindness. Since these vascular tangles can cause retinal/vitreous hemorrhages, retractions and tears in the retina, laser is applied all around the retina while protecting the center of the retina (panretinal laser photocoagulation).

In the new vessel formation phase; intraocular injections are applied with laser to dry the vessels that cause bleeding and retraction risk.

If the new vessel formation phase cannot be controlled, severe hemorrhages, retractions and tears occur in the retina.

Intraocular hemorrhages and retinal retraction detachments are repaired via vitrectomy operation. However, at this stage, serious damage and cell death have occurred in the retina. Stopping the disease before it reaches these stages has a positive effect on the visual result.

In order to contribute to retinal repair after vitrectomy operation, magnovision support may be required, along with extraocular injection of growth factors (PRP).