Interesting conversation about proliferative retinopathy
05/04/2018 5:07 p.m.
I share (at his) the conversation between @"krrs" and our beloved @"ophthalmologo", since what began being a timely consultation, has ended up being a complete topic of interest to all members of the forum, I hope youLike !!;)
KRRS 03-23-2018
Good afternoon, I go to you in case I could give me some information and tranquility, a while ago I already comment on my case about the proliferative retinopathy that I suffer, the case is that since then I am with tests of all kinds, finally a month ago I have beenThey made a laser in the right eye, in the tearing area approximately, a couple of flashes, the problem is that today they have made an angiography with fluorI tell him that they have already done so and his answer is that it is another type of non -peripheral laser and no longer tells me anything else, he does not report or anything, I have left very worried because I do not know what he could see, you would know with the fewData that I give to what type of laser refers to?I am very scared and I panic losing my eyes, it is my greatest fear, I see perfectly but this has scared me today.We are looking for a baby and this news has been a jug of cold water.Everything that can tell me according to your experience will be helpful.
Thank you so much.
Ophthalmologist 03-23-2018
I think I should request a more exhaustive explanation of the DRA, because it is very difficult to be understood by this means, but I will try.In proliferating diabetic retinopathy (RDP), it is common to have to be treated with laser the entire retina, both the peripheral, which is what seems to have been treated, as the central, except for the macula, of course.That is why the treatment is called Panfotocoagulations (Greek bread means totality).Sometimes, the neovular proliferation that is to be eliminated, is reduced to the periphery, and in those cases, that territory can be sufficient to photocagular, but the most normal is that sooner or later, you have to extend the photocoagulation to polelater.The laser is the same;The only difference is that in the periphery it is usually more powerful and intense and in posterior pole it is usually softer and less aggressive.Anyway, it has to be powerful enough to end vascular proliferation.I hope I have clarified something the subject
For a long time, no publication of the forum has come to my Facebook page, so my only contact with the group is email
KRRS 03-23-2018
And according to your experience, does this have good treatment?That is, will I lose vision quality, is it very worrying?
Ophthalmologist 03-23-2018
It is the only possible treatment, which aims to preserve the existing vision.Of course, peripheral vision (visual field) is lost in the long term and the central vision can suffer something, but according to my experience, a great quality of vision, and even life when the treatment is done in due time, thatObviously, it is before losing vision, as is your case
KRRS 03-23-2018
The truth is that DRA has not clarified anything, he told me about the laser but what kind or anything, just one "your dr will be explained because I am not specialized in this" and now I do not stop spinningTo lose vision, I understand that it is our greatest fear, the Tto does not matter whenever we do not harm our life and if with this I will keep the vision, great.
Thank you so much
Ophthalmologist 03-23-2018
If you do not specialize in "this", do not pay much attention because you may not know what needs to be done.Wait to talk to Dr. who treated you
KRRS 03-23-2018
Excuse me, could you send you the last report they gave me?To give me his opinion about what I commented.
Ophthalmologist 03-23-2018
Okay.If there are photos, better
KRRS03-23-2018
The ophthalmological exploration confirmed:
Visual acuity with maximum correction
OD: - 4.50 = 1 Nº1
OI: - 3.00 = 1 Nº1
Goldmann tonometry
OD: 17 mmHg
OI: 16 mmHg
Anterior segment
Year: healthy conjunctiva.Bright and transparent cornea.Grade IV Chamber.Pupila good reflection
photomotorTransparent crystalline.
Posterior segment (tropicamide)
OD: Pre-empowered pre-ecuatorial at 10 am
OI: Vitrea Rarefraction at 5 am (Goldmann lens, no breaks are appreciated)
AO: Good color papilla, medium and symmetrical excavation.Minimum lipid deposits in pole
later.Mild macular edema.Incipient moderate diabetic retinopathy.
Rigorous control of its metabolic status and new ophthalmological assessment in six months is recommended.
*I have to send it to it, apologize.
Ophthalmologist 03-23-2018
Well, here he does not speak at all of a proliferating retinopathy, but of an incipient retinal diabetic disease.To understand each other, if we classify the retinopathy in gravity, the RDP (proliferant) would be grade 4 and the one you present now is a grade 1, or at most 1.5.All this has nothing to do with having already photocoagulated the periphery.It looks like a report by a generalist ophthalmologist, which has not come into contact with the treatment of diabetic retinopathy
KRRS 03-23-2018
This is a private retinal specialist report, I showed it to my SS ophthalmologist and told me that I agreed but I wanted to make laser x the years of evolution I had and a possible pregnancy and today they have made the angiographyAnd has that told me the DRA, do you think it could be wrong?Is the tto that the drafted my case told me?The truth is that I left very quiet after the laser and today it has been as if it had worsened a lot in less than a month.
Ophthalmologist 03-23-2018
If the ophthalmologist who treated him with laser was agreed with the private report, where does the diagnosis of proliferative retinopathy come from?You start saying "a while ago I already comment on my case about the proliferative retinopathy that I suffer."All the analysis I have done is based on this diagnosis.I would not have said the same before a case of: "Mild macular edema. Moderate moderate incipient diabetic retinopathy", in which treatment is as lawful as observation.I insist, the treatment of a grade 1 retinopathy, has nothing to do with that of a degree 4.
KRRS 03-23-2018
I apologize because due to my ignorance I have had to understand my problem badly, between the little information that facilitates me and my total ignorance of the subject I have confused.Excuse me.But the case is real, they have made me laser in the right eye and today this, knowing correctly now what is my case I could tell me to the extent of their possibilities, that it has been possible to refer to the DRA with which you have to give me non -peripheral laser?Apologies again
Ophthalmologist 03-23-2018
If the non -peripheral laser treatment is based on angiography with fluorescein, credibility must be granted.It would be very helpful to define, count on the photographs of the test.In principle, the photocoagulation of the posterior pole seeks to abort a problem that is not very advanced.If it were, it would be impossible to treat it with Laser.
I understand that it is very distressed by this problem, but it seems to me that it is also confusing.I recommend reading everything I have written in this forum about retinopathy because it will help you correctly at your problem
KRRS 03-23-2018
I am very confused, because I thought everything was not so bad, I will wait to talk to DR and see.I want to thank you for all the help you give us, you are very kind.
Thank you very much, really.
Ophthalmologist 03-23-2018
A pleasure
KRRS 10-04-2018
Good afternoon, sorryThat bothers him again, they have already given me the comment (because they do not report) of angiography, would it be so kind to give me their opinion please?
AGF:
OD microenurismes by posterior pole, with equatorial ischemia areas
Oi similar appearance
Thank you very much again
· · Ophthalmologist 10-04-2018
Well, now is when the degree of retinopathy that presents can be defined.There are areas of equatorial ischemia, which means that it is in the neovascular pre-proliferation phase (grade III).Since the 80s, it is known that ischemia constitutes a direct cause in the formation of neovos (proliferating retinopathy).It is a retina that is not perfused (irrigated) and therefore, functionally nil.This state is irreversible, that is, although it was possible to re-vascularize it (completely impossible thing), it would no longer work again.And since it is considered essential for neo -air appears, which will cause hemorrhages and retinal tractions that will lead to tractional retinal detachments, the sensible thing is laser photocogulalarras completely to avoid it.This treatment must be exhaustive and completely eliminate ischemia areas.Once completed with laser, you would never have to worry about them anymore, although the appearance of other peers.As for the functional impact, theoretically would cause some gaps in the visual field, but in practice it will not notice anything.As for the micro-backgrounds of posterior pole, you cannot define me without seeing the photo because we do not know if they are few or many in which part of the posterior pole are located.
All this constitutes a good example of my insistence on the realization of angiographies, because it has been diagnosed by the private doctor of “moderate incipient diabetic retinopathy”, and in that report there is no reference to the ischemia of the equatorial areas, which to myjudgment, it is the most important thing it presents, and that are not incipient at all.Which means that since angiography did not do it, he did not see them, which leads us to diagnose new problems before it is too late, it will have to be done repeated angiographies each or two years depending on their metabolic control(I advise you to be annual).
I hope this clarifies your doubts, and do not try too much because it is in a good time to be treated
KRRS 10-04-2018
Excuse me but I have not understood him, I suppose it is an irreversible and serious case, I have told me in the hospital that is not serious and that I do not worry, what do I have to do now?They already gave me laser in the right eye, near the tear.Now I am more worried than before.
Ophthalmologist 10-04-2018
What needs to be done is to fill the laser ischemia areas, which are not in the tear but in the retina.The case is not serious if the evolution of ischemic lesions is treated and aborted.If ischemia results in neovascularization, we would be talking about something else.
By the way, the private doctor did not see the ischemia areas because without angiography, it is completely impossible to see them
KRRS 10-04-2018
The SS ophthalmologist has told me not to worry that it is not serious, knowing this, I should do the laser as soon as possible?Another thing is that I am looking for a baby, do you think that will accelerate the damage to the retina?I don't know why they don't do this test directly, I was convinced that my sight was fine and now I find this and considering that mood greatly affects sugar can already be done an idea ...
Ophthalmologist 10-04-2018
The evolutionary process of diabetic lesions is slow, but it is important to take into account that the ischemia areas did not begin at the time of diagnosis but are older.That said, and taking into account that the only possible treatment is the laser,The sooner it is done, before we forget the problem, but it is not urgent at all
As for the possible pregnancy, if this occurs with the already treated lesions, there does not have any problem.Of course, maintaining good control that is an inalienable principle
KRRS 10-04-2018
First of all, thank you for all your help, I am doing a fertility tto and in a few weeks we will know if I am pregnant, from there my question, I hope this can be treated, because if I do not face a fat problem.Until the end of May the ophthalmologist does not see me.
Ophthalmologist 10-04-2018
Yes, there are no problems in treating the retina during a pregnancy.None.In May, you can start treatment perfectly
KRRS 10-04-2018
Thank you very much for the information, I will do this test every year trusting that I do not advance and wait (like all) a definitive solution to this disease that almost nobody takes seriously.
Thank you.
All the best!
Ophthalmologo 04-26-2018
Enchanted to have been able to help you.This debate seems greatly illustrative and could benefit many people who are in the same state.I ignore if the conversation we have held is accessible to other members of the forum.If not, would you mind if it were?All the best
KRRS 04-26-2018
Not at all, it would be a pleasure to help someone with my case.
05/04/2018 5:07 p.m.
@fer - Diabetes Tipo 1 desde 1.998 | FreeStyle Libre 3 | Ypsomed mylife YpsoPump + CamAPS FX | Sin complicaciones. Miembro del equipo de moderación del foro.
Co-Autor de Vivir con Diabetes: El poder de la comunidad online, parte de los ingresos se destinan a financiar el foro de diabetes y mantener la comunidad online activa.
How much we thank @Ophthalmologist for your help and interest.
Keep in the forum, right?
05/04/2018 6:43 p.m.
Hija de 35 años , diabética desde los 5. Glico: normalmente de 6 , pero 6,7 la última ( 6,2 marcaba el Free)
Fiasp: 4- 4- 3 Toujeo: 20
Very good information, I hope everything goes well.Thanks Dr.
05/04/2018 6:54 p.m.
regina said:
how much we thank @ophthalmologist for their help and interest.
Keep in the forum, right?
For some time, and without knowing why, no publications appear on my Facebook page, but once you send me a message, which I receive in my e-mail, I can prick the link and answer,To the extent of my possibilities, what you ask me.That yes, the conversation will not be published unless I or my interlocutor request it, as it has been in this case.
You already know that I am at your disposal to where I can
05/04/2018 7:30 p.m.
Thank you very much for sharing it!
I have a question: when we do the background to review the retina they make us angiography?They have always told me that it is a retinography, what differences are there?Is it used to see if there are injuries equally?
@Oftalmologo Thank you very much!
05/04/2018 9:51 p.m.
DM1 desde abril 2006. 33años
Tresiba:12-14
Fiasp a demanda
Dexcom G6
Última HbA1c: 6% (junio)
Thank you for solving our doubts.
I have a question @"ophthalmologo".Every year I make a retinography.According to the results, everything is fine.Would it be convenient to make an optical coherence tomography (Oct) ???
05/04/2018 11:24 p.m.
maritxu22 said:
Thank you very much for sharing it!
I have a question: when we do the background to review the retina they make us angiography?They have always told me that it is a retinography, what differences are there?Is it used to see if there are injuries equally?
@Oftalmologo Thank you very much!
I have the same doubt.The ophthalmologist dilated the pupils and told me that everything was fine that the tension of the eyes was correct, etc, but simply looked at them.Neither angiography nor anything ...
Just looking at them can know if everything is fine?Lately, many cups are coming out in the target of my eyes when I didn't see me before ...
05/04/2018 11:31 p.m.
Maritxu: No, a retinography which is what is normally done in a review, does not resemble angiography.I have ever used the comparison of the iceberg.When one is observed in the sea, we all know that only 1/3 is seen from the entire.In retinopathy it is the same;What is seen in the background is the consequence of pathological processes that have been deetering in the depths of the retina for some time.Of course, they are detectable with angiography, and many of them with an OCT (Anaisabel), and even better with an angio-or that I have not had the opportunity to use (I've been retired 5 years now).
I hope this answer also serves Dixon.As for the "cups in the white of the eyes", do not worry.They have nothing to do with retinopathy
01/22/2020 9:09 a.m.