Background Retinopathy

There are usually no ophthalmic symptoms initially, but inspection of the fundi of most diabetics who have had the disease for ten years or more reveals, at first, a few microaneurysms. They are often on the temporal side of the macula but often scattered over the posterior pole of the fundus (Figure 21.2). These might come and go over months and the overall picture could be unchanged for several years. The vision is not affected unless the micro-aneurysms are clustered round the macular region and leak fluid, resulting in macular oedema. Exudates are also seen and these tend to form rings around areas of diseased vessels, although only one part of the ring might be present at any given point. These are yellowish-white deposits with well-defined edges, which are the result of precipitation of leaked lipo-proteins from diseased blood vessels. Capillary dilatation is a more subtle sign of diabetic retinopathy. Haemorrhages, which can be small ("dot") or large blot, result from the venous end of capillaries and are in the deep retina. Flame-shaped haemorrhages can also occur in the nerve fibre layer. "Cotton-wool" spots represent axoplasmic accumulation adjacent to micro-infarction of the retinal nerve fibre layer. They

Figure 21.2. Background diabetic retinopathy. a Early: microaneurysms and haemorrhages. b Severe: extensive haemorrhages, cotton-wool spots and venous dilatation. d

are greyish-white with poorly defined fluffy edges. Histological examination of diseased retina has shown areas of capillary closure and capillary microaneurysms. The vessel walls have thickened basement membranes and loss of mural cells (pericytes) (Figure 21.3).

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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