METHODS OF DIAGNOSIS AND TREATMENT OF DIABETIC RETINOPATHY Xolmatova Yokutxon Nematullayevna

Аннотация

Diabetic retinopathy is a progressive microvascular complication of diabetes mellitus and a leading cause of visual impairment and blindness among working-age adults worldwide. This paper provides a comprehensive review of the pathophysiological mechanisms underlying the development of diabetic retinopathy, including chronic hyperglycemia, oxidative stress, and vascular endothelial dysfunction. It classifies the disease into non-proliferative and proliferative stages, highlighting characteristic clinical features. The paper emphasizes the significance of early diagnosis through advanced techniques such as optical coherence tomography (OCT), fluorescein angiography, and OCT angiography. Keywords: Diabetic Retinopathy, Retina, Hyperglycemia, Microaneurysm, Neovascularization, Non-proliferative retinopathy, Proliferative retinopathy, Macular edema. Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus that affects the retina, the light-sensitive tissue at the back of the eye. It is recognized as one of the leading causes of preventable blindness globally. Approximately 35% to 40% of diabetic individuals develop some form of retinopathy. The condition is often asymptomatic in its early stages, making it challenging to detect without routine screening. As the prevalence of diabetes continues to rise worldwide, DR has become a significant public health concern. Its silent progression, potentially resulting in irreversible vision loss, emphasizes the importance of early detection and appropriate intervention. In many cases, patients are diagnosed only when vision has already deteriorated significantly, highlighting the need for proactive management and awareness. Understanding the pathophysiology, classification, and management options is crucial for preventing visual disability in diabetic populations. The pathogenesis of diabetic retinopathy is primarily linked to chronic hyperglycemia, which damages retinal microvasculature over time. Persistent high glucose levels lead to endothelial dysfunction, capillary basement membrane thickening, and pericyte loss. These changes result in increased vascular permeability, microaneurysm formation, and retinal ischemia. Hypoxia subsequently stimulates the upregulation of vascular endothelial growth factor (VEGF), promoting the proliferation of fragile, abnormal blood vessels a process known 571 NEW RENAISSANCE 2025 MAY INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE VOLUME 2 | ISSUE 5 as neovascularization. These vessels are prone to leakage and hemorrhage, further exacerbating retinal damage. In advanced stages, fibrous tissue formation may lead to retinal detachment and permanent vision loss. Additionally, oxidative stress and inflammation play vital roles in the progression of DR. Understanding these underlying mechanisms has enabled the development of targeted therapies, such as anti-VEGF agents, to counteract disease progression. Diabetic retinopathy is typically classified into two broad stages: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR is characterized by microaneurysms, dot and blot hemorrhages, hard exudates, and intraretinal microvascular abnormalities (IRMAs). As the disease progresses to moderate or severe NPDR, there may be increased vascular occlusion and leakage. PDR is marked by the growth of new, abnormal blood vessels on the retina and optic disc, which can rupture, leading to vitreous hemorrhage or tractional retinal detachment. Macular edema, often present at any stage, is a leading cause of vision loss and may occur independently. Symptoms include blurred vision, floaters, and dark areas in the visual field, though many patients remain asymptomatic until severe damage has occurred. Classification helps guide therapeutic decisions and monitor disease progression effectively. Accurate diagnosis of diabetic retinopathy requires a combination of clinical examination and imaging modalities. The initial step involves dilated fundus examination using direct or indirect ophthalmoscopy to visualize retinal changes. Fundus photography provides documentation and facilitates longitudinal assessment. Fluorescein angiography is a key tool for evaluating retinal vasculature, identifying leakage, ischemia, and neovascularization. Optical coherence tomography (OCT) is crucial for detecting macular edema and assessing retinal thickness with high precision. OCT angiography, a newer non-invasive imaging technique, enables visualization of retinal blood flow and microvascular abnormalities without the need for dye injection. In advanced or unclear cases, B-scan ultrasonography may be used. Early and regular screening, particularly through teleophthalmology, has improved accessibility and timely diagnosis, allowing for early intervention and better visual outcomes. The treatment of diabetic retinopathy depends on its severity and the presence of complications such as macular edema or neovascula