Diabetic retinal angiopathy in both eyes. Symptoms and treatment of diabetic retinal angiopathy

It happens that some of us had to deal with the diagnosis of retinal angiopathy. What does this mean, how serious is this violation and is it possible to cure this ailment? In any case, there is no need to panic, it is better to study as much information as possible on this issue and determine a program of action for yourself.

Retinal angiopathy - what is it?

The term "angiopathy" consists of two words: "angio" - a vessel and "patience" - a disease. With angiopathy, for some reason, the normal functioning of its vessels is disrupted. In this case, the retina receives less blood supply due to the impaired function of the vessels of the fundus.

Angiopathy is not an independent diagnosis, but a consequence of other pathologies.

With retinal angiopathy, the blood supply to the arteries and veins of the posterior wall of the eyeball changes, which leads to progressive visual impairment.

Causes

Any angiopathy appears as a result of any long-term malfunction in the body. Most often, this pathology is observed in patients whose health is impaired due to:

• pressure disorders (arterial hypertension, dystonia or hypotension);
• increased intracranial pressure of various origins (congenital pathology, in old age, due to diseases);
• systemic vasculitis;
• juvenile angiopathy (Eales disease);
• diabetes mellitus;
• vascular atherosclerosis;
• arteritis (more often in the head area);
• glaucoma;
• injuries (more often the head, neck, face);
• perinatal pathology (trauma or anomalies in newborns);
• infectious brain lesions (including congenital);
• general intoxication (for external or internal reasons);
• thrombosis;
• serious nervous shocks;
• work in hazardous industries;
• radiation injury;
• smoking;
• high scoliosis;
• over 70 years of age.

Views

Usually, the patient is diagnosed with an indication of the type of angiopathy. The type of ailment indicates the disease that caused the appearance of this eye pathology.

There are retinal angiopathy of the following types:

• traumatic;
• diabetic;
• hypertensive;
• hypotonic;
• youthful.

Disease manifestations

The main danger of retinal angiopathy lies in its asymptomatic course.

Often, retinal angiopathy is accidentally detected when examining the fundus by an ophthalmologist. When the symptoms of angiopathy are already clearly visible, then this stage of the disease already requires long and expensive treatment.

In what case is it extremely necessary to see a doctor?

This must be done immediately if a person suddenly begins to notice changes in himself in the form:

• A sharp decrease in vision. In this case, the patient has a "blur" of distant objects or he cannot read the small print.
• Frequent redness of the eyes with streaks of burst blood vessels.
• The appearance of "flies" or a veil before the eyes.
• Narrowing of the visual field and peripheral vision. At the same time, the patient may poorly see what is happening to the side of him: a driving car, an approaching person, etc.
• Feelings of throbbing in the eyes.
• Frequent eye pains with minimal exertion (working at the computer, short reading or handicraft).

The first symptoms of angiopathy are rarely taken into account, so the disease develops further.

The most common symptoms of this disease in the mature stage are:

• decrease in visual acuity and clarity;
• deterioration or loss of color sensitivity;
• narrowing of the field of vision or blurred vision;
• the appearance of lightning, dots or white lines before the eyes.

In systemic diseases, retinal angiopathy is a consequence of the general fragility of blood vessels in the body. In this case, the patient may have minor bleeding or hemorrhages (skin, nasal, streaks of blood in the feces, etc.)

The degree of angiopathy in hypertension

In hypertension, angiopathy is associated with an overflow of the bloodstream. Depending on the severity of symptoms, the disease in hypertensive patients can have different severity: 1, 2 or 3 degrees. With hypertension, the vessels of the fundus dilate and wriggle, and small hemorrhages form in the eye veins. Subsequently, the retina becomes cloudy, and hemorrhages become a constant companion of hypertensive patients.

1st degree

This is the stage when the painful process is still reversible. If you start at the same time to seriously fight the underlying disease, then changes in the eyes can be eliminated.

Retinal angiopathies in the initial stage are characterized by ophthalmic disorders of the type:

• dilated veins;
• narrowing of the arteries;
• increase in vascular tortuosity;
• discrepancy between the width of the vessels and their length.

Grade 2 (moderate)

This stage occurs if there was no timely treatment at the onset of the disease. At this stage, there are already organic changes in the vessels.

The second stage is characterized by manifestations:

• intensification of inconsistencies in the size of blood vessels and their tortuosity;
• vasoconstriction with impaired blood circulation through them;
• the phenomena of thrombosis and vascular hemorrhage;
• the appearance of microaneurysms and growths in the optic nerve region;
• narrowing of the field of vision and its fogging;
• decrease in visual acuity and the appearance of myopia.

Grade 3

With this degree, organic vascular damage is maximally expressed, and visual impairment can reach complete blindness.

Stage 3 angiopathy is characterized by symptoms:

• edema of the retina and optic nerve:
• hemorrhage in the retina;
• foci of white color:
• severe impairment of visual acuity and blurred vision (up to loss).

Types of ailment

After visiting a specialist, not only the diagnosis is established, but also the type of angiopathy. Among the types of this ailment there are angiopathies of the types:

• hypertensive;
• hypotonic;
• mixed;
• dystonic;
• diabetic;
• background;
• venous;
• traumatic.

Consider the features of each type of these types of angiopathy.

Hypertensive type

It occurs with prolonged hypertension and is caused by blood vessels overflowing with blood. This leads to degenerative changes in the retinal vascular bundle. At the same time, visual acuity often decreases and a feeling of blurredness arises. The condition can worsen if hypertension continues to progress.

By hypotonic type

It occurs due to reduced vascular tone and stagnation of blood in the vessels. This stagnation causes capillary thrombosis. In this case, hemorrhages appear in the eyeball and retina. Vision with these changes is seriously affected.

Mixed type

Caused by disorders of vascular regulation of the autonomic nervous system. Such pathology is preceded by any systemic ailments affecting the vascular network of the body. And the capillaries of the eye day suffer in the first place.

Although systemic diseases can occur at any age, the mixed form is more common in patients over 30. Such pathologies can lead to serious deterioration or loss of vision. The main manifestations of vascular disorder are the manifestations of "flashes", shroud or pain in the eyes, hemorrhage in the retina.

Treatment of mixed angiopathy is closely related to the establishment of blood circulation throughout the body. Complex treatment of the underlying disease can improve the condition of the eyes.

Diabetic

It occurs in diabetics. Lack of insulin in diabetes causes glucose metabolism disorders. However, the disease does not end with this: if the insulin hormone is insufficient, all metabolic processes (carbohydrate, protein, fat, mineral) are disturbed in the body.

In diabetes, the vessels throughout the body are narrowed and affected, starting with the capillaries and ending with the large main vessels. In this case, the blood flows more slowly, and the vessels are clogged. The lack of blood circulation creates problems in the tissues, depriving them of normal nutrition. In this case, the eyes are one of the first to be affected, manifesting themselves with a high degree of myopia or even blindness.

Background angiopathy

Appears against the background of other diseases. With this type of angiopathy, degeneration processes develop in the retina. This type of pathology is a consequence of a number of diseases or conditions: vascular ailments, blood diseases, autoimmune vasculitis, traumatic lesions of the neck or head, intoxication, diabetes mellitus, hypertension, high intracranial pressure, work with constant eye strain.

With background angiopathy, a change in the vascular walls disrupts their functioning. Persistent eye dysfunction leads to irreversible visual impairment, up to and including loss of vision.

Venous

It arises as a complication of pathologies associated with impaired blood flow. In this case, the blood flows more slowly and forms stagnation, which leads to the formation of blood clots or hemorrhages in the eyeball. Then the veins become tortuous and dilated all over. Often, such a violation occurs in hypertensive patients with experience.

Venous angiopathy can lead to multiple disorders such as blurred vision or progressive myopia. Improvement of the condition with this ailment is closely related to the therapy of the underlying disease.

Traumatic

It happens that the most insignificant injuries entail a sharp deterioration or drop in vision. Often, this is caused by injuries to the neck, brain, chest compression. Swelling after contusions, for example, leads to retinal opacities.

In traumatic angiopathy, the vessels of the cervical spine are compressed, while the eye vessels are narrowed. As a result, intracranial pressure increases, which can be stably high in this type of angiopathy. The tone of the retinal vessels suffers from this, which is expressed by constantly aggravating visual impairments, manifested by increasing myopia.

The mechanism of complications in traumatic angiopathy is associated with the fact that sudden compression of blood vessels during trauma spasms the vessels of the eyes, which causes retinal hypoxia with the release of fluid from it. Subsequently, the trauma leads to organic changes in the retina and hemorrhages in it. With this ailment, the optic nerve is also affected, which leads to severe visual impairment or loss.

In newborns

This is a special type of angiopathy that is often viewed as a normal variant. Often, such a diagnosis is made at the birth of a baby. But sometimes angiopathy in babies can be a harbinger of congenital neurological problems.

Often, angiopathy in infants occurs after head injuries due to difficult childbirth. At the same time, reddening of the eyes and the appearance of a vascular network are noticeable. Usually these manifestations pass quickly.

However, consultation with a neurologist for angiopathy of newborns is in any case required.

The retina of babies very quickly reacts to various loads (emotional, physical), changes in body position. At the same time, specialists should be alarmed by the phenomena of any venous plethora or vasoconstriction in the eyes of children.

Often, retinal angiopathy speaks of some existing pathology in the baby. Its identification and correct treatment leads to a decrease in pathological changes in the vessels of the eyes.

Provoking factors

In addition to the causes that lead to angiopathy, it is known about the factors that provoke and aggravate the course of the disease. Factors can often serve as such "shocks":

• smoking;
• old age;
• chronic intoxication (including alcoholic);
• hematological diseases with a tendency to blood clots;
• diseases with severe disorders of neurovascular regulation (due to osteochondrosis, increased cranial pressure, head injuries);
• anatomical features of the arteries.

Why is retinal angiopathy dangerous?

Angiopathy is also called a "time bomb" in the body. Impaired vascular function can lead to degenerative changes in the retina. In addition to visual impairment or myopia, the pathological process can reach its complete loss.

If you do not take retinal angiopathy seriously, this can, over time, lead to serious disorders in the form of:

• progressive deterioration of vision;
• hemorrhages in the vitreous body and retina or their degeneration;
• narrowing of the visual field;
• the progression of myopia;
• optic nerve atrophy;
• glaucoma;
• cataracts;
• retinal detachment;
• complete blindness.

In addition, angiopathy cannot be triggered. Untimely treatment of this ailment may be ineffective. It is important to catch the ailment in the phase of functional disorders, until irreparable organic changes in the retina occur.

Principles of therapy for angiopathy

Treatment for angiopathy may differ for different forms of this disease. The main principle in the treatment of any type of angiopathy is to find out the cause of the disease and treat the primary diagnosis.

That is, in case of hypertension, it is necessary to closely deal with its effective treatment, selecting drugs and constantly measuring pressure. And with diabetes, it is important to regularly take anti-hypoglycemic drugs and measure blood glucose.

In addition to general therapy, with the progression of angiopathy, the most effective methods of restoring the retina are necessarily selected. Most often, the following drug methods are used in therapy:

1. Disaggregants - drugs to improve microcirculation and tissue nutrition, strengthen the vascular wall (Actovegin, Pentoxifylline, Trental, Vasonit, etc.)
2. Medicines to reduce the permeability of the vascular wall (Ginkgo biloba, Xanthiol nicotinate).
3. Tissue metabolism activators (Cocarboxylase, ATP).
4. Vitamin therapy (Anthocyanin forte, Lutein complex, Neurorubin, vitamins B, C, E and A, nicotinic acid) to maintain good microcirculation in the eye vessels.
5. Drugs to reduce the likelihood of blood clots (Magnikor, Aspirin cardio, Trombonet, Dipyridamole, etc.)
6. Local therapy (instillation of drops with corticosteroids, Taufon, Emxi-optic, Emoxipin, Aisotin).
7. Control over cholesterol and lowering it (Pravastatin, Atorvastatin, etc.)
8. A diet that restricts high-calorie foods, salt, spices, and alcohol to slow down retinal transformation.

In addition to the main methods, the following treatment methods have proven themselves perfectly in the therapy of angiopathy:

• Special physiotherapy exercises to improve the work of blood vessels and heart, gymnastics for the eyes, yoga asanas.
• Physiotherapy (magnetotherapy, laser coagulation, acupuncture). The device "Sidorenko's Glasses" has shown itself well in this disease (it combines the effect of phonophoresis, color therapy, pneumomassage and infrasound). Also in some private clinics the innovative STIOTRON pulse therapy device is used. It is believed that this new device is able to restore the regeneration of damaged blood vessels and eliminate malfunctions in the eye itself.
• Massage ShVZ (neck-collar zone) to improve blood circulation and better outflow of blood vessels in the eyes.

Forecast

The prognosis for angiopathy closely depends on the correctness and timeliness of treatment of the underlying ailment. Often, with timely diagnosis and proper treatment, pathological processes in the vessels of the eyes can be stopped or complications can be postponed as much as possible.

However, at an advanced stage (for example, uncorrected high blood sugar or hypertension of a malignant course), angiopathy can lead to partial or absolute loss of vision.

In some cases, with a severe degree of angiopathy, the risk of retinal detachment is high. At the same time, a modern method of surgical treatment of this disease is used - the method of laser coagulation.

Prevention

Retinal angiopathy often occurs at the site of pre-existing health problems. Therefore, in order to maintain eye health, it is important to take care of your body as a whole: pay attention in a timely manner to alarming "bells" regarding high blood pressure, high blood sugar, progressive osteochondrosis, any head or neck injuries, etc. It is also extremely important not to overload your eyes with prolonged reading, sitting at the computer or TV, needlework. In addition to the obligatory pauses, for better functioning of the eye muscles, it is advisable for people of mental labor to do special exercises for the eyes 1-2 times a day (according to Zhdanov, Norbekov, etc.).

Knowing about the asymptomatic nature of the initial phases of retinal angiopathy, it is important to have an annual preventive examination by an ophthalmologist. The condition of the damaged vessels of the eyes is already irreversible and may result in blindness. That is why it is necessary to regularly visit an eye doctor for people over 40 and people with any chronic diseases. The selection of the correct treatment and lifestyle correction often helps to postpone the development of the disease for decades.

Retinal vascular abnormalities cannot be ignored. For any eye problems, you must consult a specialist. Only a qualified doctor should treat angiopathy, since different eye pathologies can have the same symptoms with completely different methods of treatment. Take care of your eyes!

Diabetic angiopathy is a vascular lesion that is a complication of long-term diabetes mellitus. The disease does not depend on gender. The most vulnerable age is after 50 years. Most often, a violation of blood flow is observed in the vessels of the lower extremities, kidneys and retina. Symmetrical changes are characteristic on both sides.

The International Classification of Diseases (ICD 10) provides 5 coding options for diabetic angiopathy, depending on the form of diabetes. All codes indicate a mandatory violation of peripheral circulation:

• E10.5 - with insulin-dependent diabetes;
• E11.5 - with an insulin-independent form of the disease;
• E12.5 - if diabetes mellitus is associated with a lack of nutrition;
• E13.5 - with other known forms of diabetes;
• E14.5 - if the causes of diabetes are not established.

Some statistics

Systemic damage to the vascular bed in patients with diabetes mellitus leads to cerebral angiopathy (encephalopathy). The frequency of this complication is from 5 to 75%, depending on the form of the disease.

In 35 - 40% of patients of working age, angiopathy is found in the vessels of the heart. It is one of the main causes of death among patients with diabetes mellitus from ischemic complications (up to 75% of cases).

The mechanism of development of pathology

In the development of the pathology of the vascular bed in diabetes mellitus, importance is attached to violations of fat and carbohydrate metabolism in the patient's body.

• The basis of the effect on blood vessels is uncompensated glycemia (high blood glucose). It leads to the accumulation of toxins, acid residues, directly affects the vessel wall.
• The increased formation of low density lipoproteins causes their accumulation in the vascular wall, the proliferation of muscle cells.
• Oxidative reactions of fats contribute to the appearance of free radicals, which have a pronounced destructive effect on the inner lining of blood vessels (endothelium).
• Blocking the synthesis of prostacyclin, which dilates blood vessels and prevents thrombus formation, leads to the opposite pathological effect.
• Changes in the peripheral nervous system first disrupt the regulation of the tone of small and medium vessels (in a reversible stage), then persistent irreversible changes occur, in which the walls of the capillaries do not respond to nerve impulses.
• The result is constriction of small arterial vessels at the precapillary level. In them, the pressure rises sharply, not enough blood enters the capillaries to supply the tissues with oxygen.
• On the other hand, there is paralysis of collateral vessels (shunts), which are located between arteries and veins. They are most developed on the legs to provide increased blood supply. Diabetic angiopathy results in the discharge of oxygenated arterial blood into nearby veins. So oxygen "sneaks" without reaching the tissues.

All subsequent changes are caused by chronic tissue hypoxia.

Anatomical changes in the vessels

With diabetes mellitus, two types of angiopathy may develop:

1. Macroangiopathy affects vessels of medium caliber and small arterioles. The most comfortable conditions are created in the arteries for the formation of atherosclerotic plaques with calcification.
2. Microangiopathy characterized by impaired blood circulation at the level of the smallest vessels (capillaries) of both arterial and venous types. The proliferation of cells of the inner membrane and the loss of adaptive regulation lead to a complete blockage of the lumen and the cessation of blood flow through the capillaries into the tissue.

In patients, both types are most often mixed. Allocation into forms of circulatory disorders is important for the treatment and diagnosis of the stage of the disease. In addition, the combination of diabetes with atherosclerosis obliterans is not excluded.

Clinical manifestations of leg angiopathy

Symptoms of diabetic angiopathy are associated with the type of disorder.

Macroangiopathy is characterized by:

• feet are cold, constantly freezing feet;
• pain in the muscles of the legs when walking (intermittent claudication) that disappears after stopping;
• in a severe stage of the disease, pain at rest, especially at night;
• cramps in the calf muscles are associated with increased excretion of potassium in the urine;
• forced position - for relief, the patient sits at night, tries to warm his legs, rubs them;
• upon examination, the doctor notes a characteristic small rash on the skin of the foot and lower leg;
• in the severe stage, there is no pulsation on the arteries of the foot;
• trophic ulcers appear with necrosis in the center, and gangrene develops when the wound becomes infected.

Patients try to rub their feet with warming ointments

Signs of microangiopathy:

• numbness of the foot, a feeling of "goose bumps", burning both during exercise and at rest;
• dry skin on the legs;
• thickening of the nails;
• small rash on the legs;
• preserved pulsation of the arteries of the foot.

The condition worsens with hypothermia of the legs, decompensation of diabetes, and short-term walking.

The level of vascular obliteration is indicated by the place of numbness (foot, lower leg, thigh), changes in the skin. In determining the stage of the disease, it is important to notice in time signs of diabetic neuropathy and changes in the configuration of the legs. The disappearance of adipose tissue on the legs ("shrinkage") and thighs indicates tissue atrophy.

Diabetic foot syndrome develops in the late stages of diabetes. It includes, in addition to angiopathy of the vessels of the legs, changes in the nervous regulation of metabolic processes, in the bones and joints of the foot. Trophic ulcers become deep, reaching the tendons and bone tissue. Dislocations and fractures occur in the foot, its shape changes.

Clinical manifestations of retinal angiopathy

For diabetes mellitus, angiopathy occurs in only one part of the body. Usually, the lesion is systemic in nature and, simultaneously with the lower extremities, it is possible to reveal a violation of blood circulation in the vessels of the eyes and kidneys.

Diabetic retinal angiopathy (retinopathy) occurs in the early stages of the disease. For her, a developmental mechanism of the type of microangiopathy is typical.

In the absence of complaints from the patient, the ophthalmologist can see changes in the fundus. They are available in 90% of patients. The risk of complete blindness with diabetes is 25 times more pronounced than without it.

Patient interviews reveal the following symptoms:

• dark spots or dots, sparks of light appear and disappear before the eyes;
• bother with cramps or pain in the eyeball;
• with overwork, throbbing pain appears in the eyes;
• frequent headaches.

A decrease in vision occurs already with severe vascular lesions.

Clinical manifestations of renal angiopathy

Diabetic damage to the renal vessels is called nephropathy. The disease develops as a microangiopathy in the main working structure - capillary glomeruli. Symptoms are associated with a violation of their ability to filter blood, cleanse from slag substances. Pathology occurs in 70% of patients with diabetes.

The main clinical manifestations:

1. Edema - first formed around the eyes in the morning, symmetrical on both sides, then fluid accumulates in the abdominal cavity, between the pleura, in the pericardial bag. The reason is the loss of protein (protein molecules are not retained, but pass through the vascular wall into the urine).
2. Hypertension - an increase in blood pressure occurs due to fluid and salt retention, increased production of renin in response to oxygen deficiency of kidney tissue. The consequence is the activation of the hormone aldosterone. Such hypertension is referred to as symptomatic, it is not associated with true hypertension.
3. Intoxication is the latest manifestation. It occurs due to the accumulation of tissue breakdown products, which are normally excreted in the urine. Patients complain of constant weakness, nausea, drowsiness. With a sufficiently high accumulation of ammonia compounds, brain damage occurs, which manifests itself in vomiting, dizziness, convulsions, and loss of consciousness.

The severity of the course of angiopathy depends on the primary damage to the organ:

• with progressive changes in the vessels of the legs without treatment, inevitable gangrene occurs, starting from the foot and above;
• retinal angiopathy leads to visual impairment to complete blindness;
• nephropathy ultimately causes renal failure, uremic coma.

Diagnostics

Damage to the vascular bed and its consequences can occur not only in diabetes mellitus, but this disease is one of the main reasons and provokes the development of atherosclerosis, hypertension, acute myocardial infarction, heart failure.

In the case of confirmed diabetes, examination of patients for early detection of complications is carried out during clinical examination. Patients must be examined by a surgeon, ophthalmologist, and urine tests are prescribed.

Laboratory diagnostics involves monitoring the residual blood nitrogen (creatinine, urea), fat composition (lipoprotein fractions, cholesterol), the glomerular filtration rate of the kidneys, the presence of b2-microglobulin in the urine, as well as determining in the general urine analysis, in addition to glucose, protein, the level of ketones Tel.

The pathological mechanism involves a breakdown of the regulatory function of nerve cells

Hardware methods:

• A complete examination by an ophthalmologist includes ophthalmoscopy, examination of the fundus, if necessary, stereoscopic photography of the retinal vessels is carried out;
• ECG and ultrasound of the heart can diagnose hypertension;
• doppler ultrasonography of the vessels of the legs checks the patency, reveals thrombosis;
• angiography of the arteries of the lower extremities using a contrast agent injected into the femoral artery, allows you to establish the degree of vessel patency;
• Ultrasound of the kidneys indicates a violation of the shape, structure (replacement by scar tissue);
• doppler ultrasonography of renal vessels shows tubular patency;
• MRI (magnetic resonance imaging) makes it possible to check the structure of organ tissues layer by layer.

When symptoms of angiopathy of the coronary and cerebral vessels appear, special methods of blood circulation research are added.

According to the state of the vascular pattern of the eye, the doctor judges other systemic lesions.

Treatment

Treatment of diabetic angiopathy requires, first of all, correction of blood glucose levels with diet and hypoglycemic agents. The constant intake of drugs and their dose are controlled by an endocrinologist.

A course of treatment with drugs of various actions is mandatory:

• drugs that affect the level of low-density lipoproteins (Atorvastatin, Rosuvastatin, Lovastatin);
• blood pressure lowering agents;
• diuretics to remove fluids;
• drugs that strengthen the vascular wall, promote expansion (Ascorutin, Troxevasin, Trental, nicotinic acid);
• anti-clotting agents (Aspirin group under coagulogram control);
• metabolic activators to improve metabolic processes in tissues (vitamins C, E, the whole group B, Solcoseryl).

Other treatments

Laser photocoagulation is used to treat diabetic retinal angiopathy. Cauterization of retinal vessels allows to preserve vision from 50 to 70% of patients (depending on the stage of the disease).

The administration of corticosteroids and drugs that suppress vascular proliferation (Ranibizumab) into the eyeball is used, 5 injections per year.

With trophic ulcers on the legs, the addition of gangrene, it is necessary to amputate the limb at a level above the tissue damage.

Diabetic angiopathy of the kidneys is treated by hemodialysis, which temporarily cleans the body of toxins.

The use of folk remedies for this serious pathology is not the main treatment. The enthusiasm of patients with decoctions, poultices and baths leads to advanced cases requiring surgical treatment. The use of any advertised means should be discussed with an endocrinologist.

Diabetic retinal angiopathy is a non-independent disease. As the name implies, the disease is a consequence of the development of diabetes mellitus in the body, one of its complications.

Angiopathy of the eyes consists in the occurrence of disturbances in the functioning of the blood vessels of the organ of vision and changes in the structure of the vascular wall of the eye. Pathological changes in the vascular wall of the eye lead to the fact that a person loses sight.

Very often, patients develop retinal angiopathy in both eyes.

Loss of vision occurs due to irreversible processes in the eye, which are:

• necrotic changes in the retina of the eyeball;
• thinning of the retina;
• retinal rupture;
• detachment of the photosensitive layer.

All these consequences of the development of eye angiopathy are combined under the general name of retinopathy.

Deterioration of vision occurs as a result of deterioration in the condition of the retina, which, in turn, occurs as a result of deterioration in the blood supply to the photosensitive layer of the organ of vision.

In the event of a complete retinal detachment, blindness occurs. Developing retinal angiopathy in both eyes can lead to complete loss of vision.

Reasons for the development of retinal angiopathy

Angiopathy is a consequence of the development of any disease that affects the state of the vascular system of the body.

Additionally, the disease can develop due to the progression of osteochondrosis of the cervical spine in the body. The cause of the appearance of disorders in the choroid of the eyeball can be autoimmune vasculitis - inflammatory lesions of the vascular system and blood diseases.

Changes in the vascular system of the fundus may indirectly indicate the degree of damage to the vascular system of the whole organism. Most often, eye angiopathy appears for the following reasons:

• hypertension of any origin;
• diabetes;
• atherosclerosis;
• hypotonic angiopathy - angiopathy that occurs with low blood pressure;
• scoliosis;
• injury - traumatic angiopathy.

In addition to the reasons that contribute to the progression of the disease, there is a whole complex of predisposing factors that affect the progression of the disease, such factors are:

1. smoking;
2. human exposure to harmful environmental factors, for example, industrial emissions;
3. various types of body intoxication;
4. the presence of congenital anomalies in the development of blood vessels;
5. advanced age.

Several types of angiopathy are known in medicine.

Types of angiopathy and its symptoms

Sugar level

The first signs of the development of disorders are the appearance of flies in front of the eyes, the appearance of darkening in the eyes, the periodic appearance of dark spots or dots in front of the eyes, the appearance of a feeling of pain in the eyes, pain in the eyeballs is possible. Very often, a sick person feels a headache and throbbing in the eyeballs after work that requires eye strain. In the future, there is a disruption in the functioning of the organs of vision, and the primary symptoms become persistent.

Depending on the type of underlying ailment, which caused the progression of the pathology of the vascular system, the following types of angiopathy are distinguished:

• diabetic angiopathy;
• hypertensive;
• hypotonic;
• traumatic;
• eales disease or juvenile angiopathy.

The main manifestation of the development of the disorder is damage to the choroid, which is detected during examination with a special apparatus in the ophthalmological office.

Depending on the reasons that led to the occurrence of the disorder, it can manifest itself during examination in the form of a narrowing or expansion of the vessels that feed the tissues of the eyeball.

The development of angiopathy can occur at any age, but people over the age of 30 are most often affected by this disease.

Characteristics of diabetic, hypo- and hypertensive angiopathy

With the development of diabetes mellitus in the body, not only small vessels are damaged, which causes the appearance of microangiopathy, but also large blood vessels that feed the eyeball.

When large blood vessels are damaged in the body, the development of macroangiopathy is observed. When macroangiopathy occurs, large-diameter blood vessels are damaged, not only in the structure of the eye, but also in other organs. Damage to large vessels throughout the body leads to disability.

High blood pressure affects the vascular wall, causing it to collapse

The progression of diabetes mellitus leads to the appearance of hypertension in the body. The development of hypertension and diabetes mellitus provokes the appearance of a complex complication, the cause of which is both diabetes mellitus and hypertension. This complication is called diabetic hypertensive angiopathy.

A complication developing under the influence of hypertension is called hypertensive angiopathy.

The increased pressure in the vascular system acts on the vascular wall, destroying its inner layer. This leads to thickening of the walls and their fibrosis. Retinal vessels begin to squeeze when crossed, which leads to impaired blood circulation. The resulting disturbances lead to the creation of conditions conducive to the formation of blood clots and hemorrhages. An increase in blood pressure leads to rupture of some blood vessels. The tortuosity of the fundus vessels is a characteristic sign of the development of hypertensive angiopathy.

In a neglected state, patients have hemorrhages in the eyeball, retinal opacification and destructive changes in the retinal tissues are observed.

Hypotonic angiopathy progresses when a person has a low blood pressure in the body. The decrease in pressure reduces the rate of blood flow, which in turn contributes to the formation of blood clots. This complication is characterized by vascular branching and pronounced dilatation of the arteries. Additionally, during the examination, pulsation of the veins is revealed, in some cases the pulsation is so strong that a person begins to feel it in the eye.

A person develops dizziness, headache and meteorological dependence.

Characteristics of traumatic and juvenile angiopathy

Traumatic angiopathy occurs when compression of the chest, skull, abdominal region occurs, or when the cervical spine is damaged. Damage to the vascular layer occurs as a result of a sharp increase in pressure and compression of blood vessels at the level of the cervical spine. A characteristic feature of this type of complication is the appearance of hemorrhages in the retinal tissues and a strong narrowing of the fundus capillaries. With the development of this complication, a sharp drop in vision is observed, which cannot always be restored in the future.

Juvenile angiopathy is a complication that has an incompletely understood etiology. The development of complications occurs against the background of an inflammatory process progressing in the walls of the vascular system. The nature of the onset of inflammation is unclear. When this pathology occurs, the appearance of hemorrhages in the retina and vitreous body of the eye is observed.

Juvenile angiopathy is the least favorable type of complication. In the process of progression, there may be an overgrowth of connective tissue and retinal detachment.

This situation leads to the progression of glaucoma and cataracts in the body.

Diagnosis and treatment of angiopathy

A complication in the form of angiopathy is detected when examining the fundus in the ophthalmologist's office.

The ophthalmologist examines the fundus of a patient with a dilated pupil using a special microscope. During the examination, the ophthalmologist detects the presence of vasoconstriction and dilation, the presence of hemorrhage and the position of the macula.

Additional examinations are prescribed if necessary. To diagnose the disease, the following are used:

1. Ultrasound of the vessels of the organs of vision with duplex and Doppler scanning of the vessels of the retina makes it possible to determine the velocity of blood flow and to assess the condition of the walls of blood vessels.
2. X-ray examination with the use of a contrast agent allows you to assess the patency of the vascular system and the speed of blood flow through the vessels.
3. Computer diagnostics.
4. Magnetic resonance imaging is used to assess the state of the soft tissues of the organ of vision.

Treatment of the disease should be started at the earliest stage of development. This approach will avoid the appearance of a whole complex of complications, among which the main ones are the following:

• loss of vision, which can be complete or partial;
• atrophy of the optic nerve;
• significant narrowing of the field of view.

Angiopathy is an ailment that requires an integrated approach to treatment. In the process of choosing a treatment regimen, it is required to consult with several doctors, the main specialists among them are:

1. cardiologist;
2. therapist;
3. neuropathologist;
4. ophthalmologist.

The choice of the treatment regimen is carried out by the attending physicians, taking into account the individual approach, the form of the disease and taking into account the characteristics of the patient's body.

Prevention of the development of the disease

When a hypertensive form of the disease is detected, first of all, the blood pressure indicator should be normalized and maintained at the same level.

When detecting a diabetic form of angiopathy, first of all, you should pay attention to the diet. The menu of a person suffering from diabetes should contain foods with a minimum content of sugars, these are different.

In the process of carrying out medical procedures, one should not forget about moderate physical activity, which helps to strengthen the circulatory system and the body as a whole, and also helps to improve the absorption of sugar by the muscular system. In the process of treatment, medication, physiotherapy and folk methods are used.

The main methods of prevention are activities aimed at maintaining the body in a normal functional state. For this purpose, people with high blood pressure should be regularly examined by cardiologists, and in the presence of diabetes mellitus in the body, it is required to regularly monitor the blood sugar content and regularly consult an endocrinologist. Patients should lead a healthy lifestyle, give up bad habits and follow a diet developed by nutritionists.

People with diabetes must strictly follow a low-carb diet.

The doctor will tell in the video in this article how diabetes and eye angiopathy are related.

Diabetic angiopathy is a vascular lesion that is a complication of long-term diabetes mellitus. The disease does not depend on gender. The most vulnerable age is after 50 years. Most often, a violation of blood flow is observed in the vessels of the lower extremities, kidneys and retina. Symmetrical changes are characteristic on both sides.

The International Classification of Diseases (ICD 10) provides 5 coding options for diabetic angiopathy, depending on the form of diabetes. All codes indicate a mandatory violation of peripheral circulation:

• E10.5 - with insulin-dependent diabetes;
• E11.5 - with an insulin-independent form of the disease;
• E12.5 - if diabetes mellitus is associated with a lack of nutrition;
• E13.5 - with other known forms of diabetes;
• E14.5 - if the causes of diabetes are not established.

Some statistics

Systemic damage to the vascular bed in patients with diabetes mellitus leads to cerebral angiopathy (encephalopathy). The frequency of this complication is from 5 to 75%, depending on the form of the disease.

In 35 - 40% of patients of working age, angiopathy is found in the vessels of the heart. It is one of the main causes of death among patients with diabetes mellitus from ischemic complications (up to 75% of cases).

The mechanism of development of pathology

In the development of the pathology of the vascular bed in diabetes mellitus, importance is attached to violations of fat and carbohydrate metabolism in the patient's body.

• The basis of the effect on blood vessels is uncompensated glycemia (high blood glucose). It leads to the accumulation of toxins, acid residues, directly affects the vessel wall.
• The increased formation of low density lipoproteins causes their accumulation in the vascular wall, the proliferation of muscle cells.
• Oxidative reactions of fats contribute to the appearance of free radicals, which have a pronounced destructive effect on the inner lining of blood vessels (endothelium).
• Blocking the synthesis of prostacyclin, which dilates blood vessels and prevents thrombus formation, leads to the opposite pathological effect.
• Changes in the peripheral nervous system first disrupt the regulation of the tone of small and medium vessels (in a reversible stage), then persistent irreversible changes occur, in which the walls of the capillaries do not respond to nerve impulses.
• The result is constriction of small arterial vessels at the precapillary level. In them, the pressure rises sharply, not enough blood enters the capillaries to supply the tissues with oxygen.
• On the other hand, there is paralysis of collateral vessels (shunts), which are located between arteries and veins. They are most developed on the legs to provide increased blood supply. Diabetic angiopathy results in the discharge of oxygenated arterial blood into nearby veins. So oxygen "sneaks" without reaching the tissues.

All subsequent changes are caused by chronic tissue hypoxia.

Anatomical changes in the vessels

With diabetes mellitus, two types of angiopathy may develop:

1. Macroangiopathy affects vessels of medium caliber and small arterioles. The most comfortable conditions are created in the arteries for the formation of atherosclerotic plaques with calcification.
2. Microangiopathy characterized by impaired blood circulation at the level of the smallest vessels (capillaries) of both arterial and venous types. The proliferation of cells of the inner membrane and the loss of adaptive regulation lead to a complete blockage of the lumen and the cessation of blood flow through the capillaries into the tissue.

In patients, both types are most often mixed. Allocation into forms of circulatory disorders is important for the treatment and diagnosis of the stage of the disease. In addition, the combination of diabetes with atherosclerosis obliterans is not excluded.

Clinical manifestations of leg angiopathy

Symptoms of diabetic angiopathy are associated with the type of disorder.

Macroangiopathy is characterized by:

• feet are cold, constantly freezing feet;
• pain in the muscles of the legs when walking (intermittent claudication) that disappears after stopping;
• in a severe stage of the disease, pain at rest, especially at night;
• cramps in the calf muscles are associated with increased excretion of potassium in the urine;
• forced position - for relief, the patient sits at night, tries to warm his legs, rubs them;
• upon examination, the doctor notes a characteristic small rash on the skin of the foot and lower leg;
• in the severe stage, there is no pulsation on the arteries of the foot;
• trophic ulcers appear with necrosis in the center, and gangrene develops when the wound becomes infected.

Patients try to rub their feet with warming ointments

Signs of microangiopathy:

• numbness of the foot, a feeling of "goose bumps", burning both during exercise and at rest;
• dry skin on the legs;
• thickening of the nails;
• small rash on the legs;
• preserved pulsation of the arteries of the foot.

The condition worsens with hypothermia of the legs, decompensation of diabetes, and short-term walking.

The level of vascular obliteration is indicated by the place of numbness (foot, lower leg, thigh), changes in the skin. In determining the stage of the disease, it is important to notice in time signs of diabetic neuropathy and changes in the configuration of the legs. The disappearance of adipose tissue on the legs ("shrinkage") and thighs indicates tissue atrophy.

Formed in the late stages of diabetes. It includes, in addition to angiopathy of the vessels of the legs, changes in the nervous regulation of metabolic processes, in the bones and joints of the foot. Trophic ulcers become deep, reaching the tendons and bone tissue. Dislocations and fractures occur in the foot, its shape changes.

Clinical manifestations of retinal angiopathy

For diabetes mellitus, angiopathy occurs in only one part of the body. Usually, the lesion is systemic in nature and, simultaneously with the lower extremities, it is possible to reveal a violation of blood circulation in the vessels of the eyes and kidneys.

Diabetic retinal angiopathy (retinopathy) occurs in the early stages of the disease. For her, a developmental mechanism of the type of microangiopathy is typical.

In the absence of complaints from the patient, the ophthalmologist can see changes in the fundus. They are available in 90% of patients. The risk of complete blindness with diabetes is 25 times more pronounced than without it.

Patient interviews reveal the following symptoms:

• dark spots or dots, sparks of light appear and disappear before the eyes;
• bother with cramps or pain in the eyeball;
• with overwork, throbbing pain appears in the eyes;
• frequent headaches.

A decrease in vision occurs already with severe vascular lesions.

Clinical manifestations of renal angiopathy

Diabetic damage to the renal vessels is called nephropathy. The disease develops as a microangiopathy in the main working structure - capillary glomeruli. Symptoms are associated with a violation of their ability to filter blood, cleanse from slag substances. Pathology occurs in 70% of patients with diabetes.

The main clinical manifestations:

1. Edema - first formed around the eyes in the morning, symmetrical on both sides, then fluid accumulates in the abdominal cavity, between the pleura, in the pericardial bag. The reason is the loss of protein (protein molecules are not retained, but pass through the vascular wall into the urine).
2. Hypertension - an increase in blood pressure occurs due to fluid and salt retention, increased production of renin in response to oxygen deficiency of kidney tissue. The consequence is the activation of the hormone aldosterone. Such hypertension is referred to as symptomatic, it is not associated with true hypertension.
3. Intoxication is the latest manifestation. It occurs due to the accumulation of tissue breakdown products, which are normally excreted in the urine. Patients complain of constant weakness, nausea, drowsiness. With a sufficiently high accumulation of ammonia compounds, brain damage occurs, which manifests itself in vomiting, dizziness, convulsions, and loss of consciousness.

The severity of the course of angiopathy depends on the primary damage to the organ:

• with progressive changes in the vessels of the legs without treatment, inevitable gangrene occurs, starting from the foot and above;
• retinal angiopathy leads to visual impairment to complete blindness;
• nephropathy ultimately causes renal failure, uremic coma.

Diagnostics

Damage to the vascular bed and its consequences can occur not only in diabetes mellitus, but this disease is one of the main reasons and provokes the development of atherosclerosis, hypertension, acute myocardial infarction, heart failure.

In the case of confirmed diabetes, examination of patients for early detection of complications is carried out during clinical examination. Patients must be examined by a surgeon, ophthalmologist, and urine tests are prescribed.

Laboratory diagnostics involves monitoring the residual blood nitrogen (creatinine, urea), fat composition (lipoprotein fractions, cholesterol), the glomerular filtration rate of the kidneys, the presence of b2-microglobulin in the urine, as well as determining in the general urine analysis, in addition to glucose, protein, the level of ketones Tel.

The pathological mechanism involves a breakdown of the regulatory function of nerve cells

Hardware methods:

• A complete examination by an ophthalmologist includes ophthalmoscopy, examination of the fundus, if necessary, stereoscopic photography of the retinal vessels is carried out;
• ECG and ultrasound of the heart can diagnose hypertension;
• doppler ultrasonography of the vessels of the legs checks the patency, reveals thrombosis;
• angiography of the arteries of the lower extremities using a contrast agent injected into the femoral artery, allows you to establish the degree of vessel patency;
• Ultrasound of the kidneys indicates a violation of the shape, structure (replacement by scar tissue);
• doppler ultrasonography of renal vessels shows tubular patency;
• MRI (magnetic resonance imaging) makes it possible to check the structure of organ tissues layer by layer.

When symptoms of angiopathy of the coronary and cerebral vessels appear, special methods of blood circulation research are added.

According to the state of the vascular pattern of the eye, the doctor judges other systemic lesions.

Treatment

Treatment of diabetic angiopathy requires, first of all, correction of blood glucose levels with diet and hypoglycemic agents. The constant intake of drugs and their dose are controlled by an endocrinologist.

A course of treatment with drugs of various actions is mandatory:

• drugs that affect the level of low-density lipoproteins (Atorvastatin, Rosuvastatin, Lovastatin);
• blood pressure lowering agents;
• diuretics to remove fluids;
• drugs that strengthen the vascular wall, promote expansion (Ascorutin, Troxevasin, Trental, nicotinic acid);
• anti-clotting agents (Aspirin group under coagulogram control);
• metabolic activators to improve metabolic processes in tissues (vitamins C, E, the whole group B, Solcoseryl).

Other treatments

Laser photocoagulation is used to treat diabetic retinal angiopathy. Cauterization of retinal vessels allows to preserve vision from 50 to 70% of patients (depending on the stage of the disease).

The administration of corticosteroids and drugs that suppress vascular proliferation (Ranibizumab) into the eyeball is used, 5 injections per year.

With trophic ulcers on the legs, the addition of gangrene, it is necessary to amputate the limb at a level above the tissue damage.

Diabetic angiopathy of the kidneys is treated by hemodialysis, which temporarily cleans the body of toxins.

The use of folk remedies for this serious pathology is not the main treatment. The enthusiasm of patients with decoctions, poultices and baths leads to advanced cases requiring surgical treatment. The use of any advertised means should be discussed with an endocrinologist.

With angiopathy, destabilization of the tone of the blood vessels occurs, the cause of which is a disorder of nervous regulation. In the lumen, the inflow (outflow) of blood worsens. As is known, angiopathy of the retinal vessels is manifested by a pathological change that is a continuation of many diseases. Not being an independent disease, it signals other pathological processes affecting the vessels. Damage to the capillaries, blood vessels of the eye is caused mainly by spasms, vascular paresis. Doctors pay serious attention to such a disorder, because in a neglected state, angiopathy threatens with loss of vision.

Damage to the vessels of the eye tissue affects adults, children, but more often it manifests itself after 30 years. In a child, retinal angiopathy is characterized by a rather objective sign. It changes with a change in the position of the child (sitting or standing), with physical exertion. In adults, naturally, against the background of a persistent increase in pressure, microangiopathy of the brain is also quite often manifested. Inaction will lead to pathological, possibly irreversible processes.

Complications of the disease are expressed in optic nerve atrophy; narrowing of the visual fields, loss of vision (partial, complete). There is a classification of diseases that cause retinal angiopathy. Accordingly, several types of this disease have been identified.

Types of angiopathy of the eye

The main types of retinal angiopathy are as follows:

1. Youthful.
2. Hypertensive.
3. Traumatic.
4. Hypotonic.
5. Diabetic.

Eales disease is a problem for young men

The first type is considered the most unfavorable. Also called Eales disease. The etiology of juvenile angiopathy is not clear. It is characterized by inflammation of the retinal vessels, usually venous. Hemorrhage is observed in the retina, vitreous body. Connective tissue is also formed inside them. Sometimes complications arise, for example, retinal detachment, glaucoma, cataracts.

Hypertensive angiopathy: sharply narrowed second-order arterioles.

Hypertensive type

Hypertensive angiopathy is a consequence. In the fundus, uneven narrowing of the arteries begins to appear. The presence of hypertension almost always leads to a violation of the structure of the retina. This is marked by the branching of the veins, their expansion. In the eyeball, punctate hemorrhages occur. Clouding of the eyeball may occur. In advanced cases, a complete change in the retinal tissue is possible. With the elimination of hypertension, the condition of the fundus improves. This hypertensive type of disease also occurs in pregnant women. It usually begins after the sixth month of fetal development.

Angiopathy as a consequence of trauma

Traumatic angiopathy occurs, as is known, due to compression of the chest, with injuries of the spine (cervical spine), increased intracranial pressure, and brain injury. The onset of atrophy in the optic nerve is fraught with visual impairment. Timely treatment will prevent retinal detachment and glaucoma.

Hypotonic view

Hypotonic angiopathy usually manifests itself when the tone of the vessels (small) decreases. Overflow of blood vessels begins, and a decrease in blood flow may also occur. This will result in blood clots. This type of angiopathy is characterized by palpable pulsation, dilated arteries, branching.

Micro and Macro Disorder in Diabetes

Diabetic angiopathy is very common. Its appearance is associated with the fact of untimely treatment. Moreover, two types are noted: and macroangiopathy. The first type is the defeat of the capillaries, when their walls become thinner. Because of this, blood penetrates into the adjacent tissues - hemorrhage occurs. Blood circulation is also impaired. The defeat of large vessels is a macroangiopathy. If diabetes is left untreated and high blood levels are recorded, diabetic microangiopathy is at risk. From the inside of the vascular wall, fat will accumulate, which will lead to its compaction. Further, there will be a blockage of blood vessels, causing hypoxia of the retinal tissues. This type of disorder causes ischemic disease. Peripheral vessels also suffer.

The causes of angiopathy. Symptoms

The reasons for the development of the disease, according to doctors, are the following factors:

• Disorder of nervous regulation, of course, responsible for vascular tone;
• Injuries to the brain, spine (namely the cervical vertebrae);
• Increased intracranial pressure;
• Harmful working conditions;
• Eye trauma;
• Smoking;
• Features of the structure of blood vessels (congenital);
• Various blood diseases;
• Elderly age;
• Arterial hypertension;
• Systemic (a form of vasopathy);
• Intoxication of the body;
• Presbyopia of the eyes.

The causes of juvenile angiopathy require additional research. This is a rare type of this disease. The main cause of vascular damage is undoubtedly the neglected form of diabetes, which causes a violation of hemostasis. But sometimes a similar deviation, unfortunately, is observed in a newborn, although he does not have the above diseases. Retinal angiopathy is detected in the hospital. But worry about this is premature. The disease may be a consequence of difficult childbirth. Most often, there is no threat to the vision of a newborn. After some time, this pathology will pass by itself.

Gvist's symptom, in which yellow spots appear on the eyeball, is a sign of a hypertensive type of eye lesion.

The symptoms of angiopathy are manifested as follows:

1. Deterioration of vision (the image becomes cloudy);
2. "Lightning" in the eyes.
3. Vision is completely lost;
4. Worried;
5. Leg pain;
6. Progressive myopia is observed;
7. Retinal dystrophy manifests itself;
8. Blood in the urine
9. Gastrointestinal bleeding occurs.

On the eyeball, yellow spots, branching of blood vessels, tortuous small vessels, and punctate hemorrhages are clearly visible. The patient often with hypotonic angiopathy feels pulsation in the fundus.

Diagnostics. Prescribing treatment

For the correct, effective treatment of retinal angiopathy, professional diagnosis is very important. The disease is diagnosed, of course, only by an ophthalmologist. To clarify the diagnosis, special studies will be required, for example, an ultrasound scan of the vessels, which provides information on the speed of blood circulation. Thanks to Doppler (duplex) scanning, the specialist sees the condition of the vessel walls.

X-ray examination is also effective. During the procedure, a radiopaque substance is injected to determine the patency of the vessels. Magnetic resonance imaging can sometimes be used. This helps to visually examine the state of soft tissues.

Having discovered angiopathy, the doctor prescribes effective drugs to improve blood circulation: pentylin, vasonite, arbiflex, solcoseryl, trental. True, during pregnancy, it is undesirable to treat angiopathy with medication. Chemical effects on the fetus should be completely eliminated in order to maintain health. Therefore, doctors prudently do not prescribe drugs, in particular those that improve blood circulation. Sparing physiotherapy methods are selected.

For the treatment of diabetic angiopathy, a special diet must be added to the prescribed drugs. It is required to exclude carbohydrate foods from the daily diet. Doctors also recommend light (not straining) physical activity, which will contribute to the necessary consumption of sugar by the muscles, improve the condition, and normal functioning of the cardiovascular system. TO

when there is increased fragility of blood vessels, it is advisable to prescribe calcium dobesylate. Thanks to the drug, blood microcirculation improves, blood viscosity decreases to the required extent, vascular permeability is rather effectively normalized.

In the treatment of angiopathy in both eyes, the use of physiotherapy methods can be envisaged. Various procedures (for example, laser irradiation, magnetotherapy, acupuncture) improve the general condition.

In hypertensive angiopathy, treatment aimed at normalizing blood pressure, significantly lowering cholesterol levels is effective. Appropriate diet is prescribed. The ophthalmologist usually prescribes eye drops, vitamins (Anthocyanin Forte, Lutein). When the state of angiopathy is neglected, hemodialysis is prescribed. The procedure helps to cleanse the blood.