COMPLICATIONS OF DIABETIC RETINOPATHY

Abstract

Diabetic retinopathy (DR) is one of the most significant microvascular complications of diabetes mellitus and a leading cause of acquired blindness in the working-age population in developed countries. The aim of this paper is to comprehensively analyse the main complications of diabetic retinopathy, namely diabetic macular edema (DME), vitreous hemorrhage, retinal detachment, and neovascular glaucoma, as well as the modern therapeutic approaches available for their management. The paper is based on a review of relevant scientific literature, clinical guidelines, and epidemiological data from international and regional sources. The global prevalence of diabetic retinopathy is estimated at approximately 34.6% among all persons with diabetes, with proliferative diabetic retinopathy (PDR) affecting around 10.2% and DME present in approximately 8.6%. In North Macedonia, over 100,000 individuals live with diabetes, and at least 30% are estimated to have signs of retinopathy, with approximately 10% at high risk of vision loss. Diabetic macular edema, caused by increased vascular permeability and disruption of the blood-retinal barrier mediated primarily by VEGF, represents the most common cause of visual impairment in DR. Vitreous hemorrhage results from rupture of newly formed, fragile neovascular vessels in proliferative DR and may lead to permanent vision loss if untreated. Tractional retinal detachment arises through fibrovascular membrane formation and contraction at the vitreoretinal interface. Neovascular glaucoma, driven by anterior segment neovascularization from ischemia-induced VEGF overproduction, results in acute intraocular pressure elevation and rapid optic nerve damage. The primary treatment modalities include anti-VEGF intravitreal injections (ranibizumab, aflibercept), laser photocoagulation (focal, grid, and panretinal), and vitrectomy for advanced cases. Anti-VEGF therapy has revolutionized DME management and is now the first-line treatment, achieving visual acuity improvement of 15 or more ETDRS letters in 34-50% of treated patients. Panretinal photocoagulation remains a cornerstone for PDR, reducing the risk of severe vision loss by 50-60%. Early vitrectomy is superior in type 1 diabetes patients with severe vitreous hemorrhage. The findings underscore that timely diagnosis, regular ophthalmological screening, optimal glycaemic control, and multidisciplinary collaboration are essential for preventing progression and preserving visual function. An estimated 90% of severe vision loss cases related to DR are preventable with appropriate intervention.