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The satisfactory control of diabetes with insulin has increased the incidence of eye complications, for it has become apparent that it is the duration of the disease rather than its severity that determines the onset of ocular changes. A special type of cataract may occur in young diabetics with severe untreated disease, but the most serious complication involves the blood vessels of the retina. The actual cause of the changes in the retinal vessels is still unknown, but the natural history of the disease is well recognized. The retinal capillaries dilate at weak points in the vessel wall—i.e., form small aneurysms; these weak portions of the vessel wall may give way and cause hemorrhages into the retina. In the later stages the hemorrhages become more extensive and spread into the vitreous. New vessels grow into hemorrhagic areas and are followed by fibrous changes that may pull on the retina and cause detachment. Extensive changes of this nature lead invariably to blindness.
Destruction of the pituitary gland, either by direct surgery or by the implantation of a radioactive material, has given some hope of alleviating these severe retinal changes. The procedure is, however, a drastic one. Destruction of affected areas of the retina by the use of an intense beam of light, a process called photocoagulation, promises to be a useful form of treatment in selected cases. Degenerative changes in the retina remain the most serious complication of diabetes.
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