Vitreous detachment in diabetes

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The significance of the relationship between the vitreous body and the retina in the development of its diabetic damage is proven by data from Takahachi and other authors [252]. The authors indicated that in proliferative retinopathy compared with non-proliferative retinopathy, vitreous detachment is much more common, which, according to them, is not the only trigger in the development of proliferative changes, but contributes to their emergence and stimulates frequent deteriorations in the proliferative process.

We have confirmed evidence that the local detachment of the vitreous body is an unfavourable factor contributing to the progression of diabetic retinopathy. At the same time, in complete vitreous detachment, no diabetic retinal changes were observed or they were minimal. We have described a case where local vitreous detachment «tore» the retinal vein out of the lodge and led to hemophthalmia later (Fig 1.2.)

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Fig. 2. Patient I., Local vitreous detachment and a vein torn out of the lodge

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Fig. 3 . Patient I., Condition after hemophthalmia and the vitreous body.

Thus, micro-local retinal detachment is formed by toxic products «bombing» places of contact between vitreous fibrils and Mueller cells (membrana limiting interna). This connection (shown in biochemical studies) is very weak. That is why vitreous micro detachment is formed (partial vitreous detachment)

The biochemical studies of the vitreous body conducted by me indicate that the vitreous body contains a high activity of glutathione peroxidase. This helps the retina to neutralize toxic substances.

In vitreous micro detachment, retinal contact with vitreous contents is lost (missing). Therefore, it is in this place where connective tissue (proliferation tissue) can develop.

At the same time, total vitreous detachment, which is often observed in high myopia and retinal degeneration, has a beneficial effect on the retina.

Here, there are two factors: 1. retinal dystrophy itself is a favourable factor, since dystrophy of the outer layer of the retina is an antagonist of the internal diseases of the retina.

  1. Vitreous enzymes (glutathione peroxidase and others) synthesizing in the ciliary body bypass the detached membrane and help neutralize toxic products.

But the most important thing is the positive effect of the degeneration of the outer layer of the retina on the course of retinopathy.

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The scheme of the lack of retinal protection by the antioxidant system of the vitreous body within its local detachment zone

The scheme of the possible protection of the retina by the antioxidant system of the vitreous body of the intraocular fluid produced by the ciliary body bypassing the vitreous body

References

  1. Hajiyev R.V. Diabetic retinopathy, Baku, «Elm», 1999, p. 71.
  2. Gajiyev Posterior vitreous detachment in pathogenesis of diabitic retinopathy. Ophthalmosurgery (ISSN 0235-4160), 1992, 2, p.48-52
  3. Aliyeva Z.A., Gadzhiev R.V., Sultanov M.Y. About the passible role of antioxidant system of the vitreous body delayed development of diabitic retinopathy. Oftalmologiceskiy journal 1985, 3, p. 142-145.

 

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