Retinopatia diabetica
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ll diabete di tipo 1 rappresenta la tipica forma autoimmune del diabete. L’insorgenza è tipica dell’età infanto-giovanile, ma può essere possibile a ogni età . Nel 5-10% degli adulti che sviluppano diabete dopo i 40 anni viene riconosciuta una eziologia autoimmune. Frequentemente questa forma di diabete è associata ad altre malattie autoimmuni, quali il morbo di Addison, malattia di Graves, tiroide autoimmune, celiachia e gastrite autoimmune.
Il diabete mellito di tipo 2, un tempo noto come diabete non insulino-dipendente dell’adulto, rappresenta un gruppo eterogeneo di disordini caratterizzati da gravi variabili d’insulino-resistenza, con aumentata produzione epatica e riduzione dell’uptake periferico di glucosio, oltre che da alterata secrezione insulinica. Questa forma di DM può non essere riconosciuta per anni, in quanto l’iperglicemia è frequentemente asintomatica.
RETINOPATIA DIABETICA
Il DM è la causa principale di cecità nell’area compresa tra 20 e 74 anni negli Stati Uniti. Dopo vent’anni di DM quasi tutti i pazienti con diabete tipo 1 e il 60% dei pazienti con diabete tipo 2 presentano un certo grado di retinopatia. La durata del DM, il livello di controllo glicemico sono i migliori predittori dello sviluppo di retinopatia. La retinopatia diabetica è classificataÂ
in due stadi: non proliferativa e proliferativa.
La retinopatia diabetica non proliferativa solitamente appare verso la prima la fine della prima decade o l’inizio della seconda decade di malattia ed è caratterizzata da microaneurismi vascolari della retina, emorragie puntiformi, ed essudati cotonosi. La progressione è determinata dalla comparsa di modificazioni del calibro dei vasi venosi, anomalie microvascolari intraretiniche, e aumento del numero di microaneurismi e di emorragie. La perdita dei periciti retinici, le alterazioni del flusso ematico retinico, e l’abnorme microvascolarizzazione della retina possono indurre ischemia retinica; tutti questi fattori sono implicati nella patogenesi della retinopatia non proliferativa.Â
La retinopatia diabetica non proliferativa non determina disturbi visivi se la zona della macula non è danneggiata da un edema retinico, da una placca di essudato o da una emorragia. La fluorangiografia è spesso utile per identificare l’edema maculare, che è associato a una probabilità del 25% di moderata perdita visiva nei successivi 3 anni.Â
Il carattere distintivo della retinopatia diabetica proliferativa è la comparsa di neovascolarizzazione in risposta all’ipossia retinica.Â
I vasi neoformati possono apparire in corrispondenza del nervo ottico e/o della macula e possono rompersi facilmente, determinando emorragia del vitreo e il distacco retinico per la formazione di tessuto fibroso con marcata tendenza alla retrazione. Più la malattia non proliferativa è severa, maggiore è la possibilità di evolvere verso la retinopatia proliferativa entro 5 anni,Â
per cui è necessario un precoce riconoscimento e trattamento della retinopatia diabetica.Â
PREVENZIONE
La prevenzione della retinopatia diabetica e il controllo oculistico periodico sono fondamentali. Lo screening prevede un controllo annuale del fondo oculare nel caso di assenza di retinopatia non proliferante di grado lieve e controlli più ravvicinati e l’esecuzione della fluorangiografia retinica per caso i più avanzati. Un controllo glicemico ottimale ritarda lo sviluppo, rallenta la progressione della retinopatia negli individui sia dal DM di tipo 1 sia da DM di tipo 2.
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