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Mr McHugh’s surgical interests include cataract and vitreoretinal surgery, that are carried out at either The London Clinic in Devonshire Place, or The Wellington Hospital in St.
Retinal laser therapy is also performed for the treatment of retinal tears and the complications of diabetic retinopathy and other retinal vascular conditions.
There are a number of conditions that can now be treated by the injection of drugs into the eye and these include Avastin, Lucentis and steroids and Dominic McHugh can offer these treatments for diabetic retinopathy and macular degeneration. Macular disease due for example to macular degeneration, or the development of a macular hole can cause a profound loss in central vision. The IOL-Vip system consists of two lens implants which are inserted into the eye following the removal of the patient’s own lens during a standard cataract procedure. Before undergoing such a procedure, patients undergo evaluation of suitability for surgery. The following video and powerpoint presentation provides more information about the IOL-Vip system. F Chiarelli Received January 26, 2010 AbstractObjective: To review currently available evidence on the molecular mechanisms, risk factors and outcomes of mico- and macrovascular complications in children with type 1 diabetes mellitus.
Mr McHugh was a pioneer in the development of the portable, semi-conductor diode laser and he performs low energy ‘micro pulsed’ therapy in order to minimise the potential side-effects of laser treatment. Although treatments are available, if they are unsuccessful or the patient presents with advanced or chronic pathology then irreversible visual deterioration may occur.
This involves a dedicated visual assessment software programme and a simulation device, which provide a prediction of the likely visual outcome from surgery.
Data sources and study selection: Medline, Pubmed, and Cochrane Library searches of internationally published English language journals, from 1985 to February 2010 using the terms "diabetes", "children", "complications", "angiopathy" and "management".
Cataract surgery is performed using small incisional phacoemulsification techniques with injectable lens implants. Recent advances in lens implant technology have provided the possibility of improving a patient’s vision despite the presence of macular damage.
In addition, the system provides a prismatic effect, in that sight entering the eye is ‘bent away’ from the damaged area and images instead are projected onto an area of undamaged retina. Data extraction: All articles involving diabetes vascular complications in children were included in the review. Vitreoretinal surgery is employed for a wide variety of conditions, including retinal detachment, advanced diabetic retinopathy causing vitreous haemorrhage and retinal detachment, macular holes and epiretinal membranes.
A number of studies have shown a significant improvement in patients’ ability to read following this procedure.
Data synthesis: During the natural history of diabetes several molecular, receptorial and cellular factors provide a continuous mechanism of vascular damage. Even if patients have already undergone cataract surgery with lens implantation, they may still be suitable for IOL-Vip surgery. In children with diabetes this state is present at an early age so that accelerated atherosclerosis is associated with an increased risk of micro- and macrovascular complications as compared to the non-diabetic paediatric population. The major long term complications of diabetes can be divided into micro- (nephropathy, retinopathy and neuropathy) and macrovascular complications.
Childhood remains a period during which intensive education and treatment may prevent or delay the onset and progression of these complications.
Conclusions: Although the prognosis has improved considerably in recent years due to the advances in the therapeutic interventions, systematic regular screening continues to have a pivotal role in the management of complications in diabetic children. Primary prevention to all risk factors for vascular complications is essential and intervention is indicated if necessary even in childhood. Intensive education and treatment during childhood and adolescence may prevent or delay the onset and progression of complications.2 T2DM is an increasing problem in childhood, however type 1 remains by far the most common type of diabetes in this age group in the Western world.

In this review we have focused on T1DM, because this will have the greatest implication for patients diagnosed in childhood.
Risk factors such as hyperglycaemia, oxidised low-density lipoprotein (LDL) cholesterol, hypertension and aging increase the production of free radicals. Hyperglycaemia activates PKC, PP, HBP and is associated with an increased production of AGEs.
All these factors can induce oxidative stress through the mitochondrial, enzymatic and non-enzymatic pathways. Many of these effects are normalised by uncoupling of oxidative phosphorylation and by overexpression of MnSOD.20 ROS contribute also to the pathogenesis of neuropathy as clearly demonstrated by several experimental studies. The oxidative stress-related dysfunction of both endothelial and smooth muscle cells have a pivotal role in the progression of diabetic macroangiopathy. Early detection of diabetic nephropathy and timely treatment of early signs of this complication have a pivotal role in the prevention of end-stage renal failure in children and adolescents with diabetes.57 Therefore, regular screening for DN, are of foremost importance in paediatric diabetes care. In the case of pubertal onset of diabetes, complication screening should be initiated 2 years after onset, and annually thereafter. The Diabetes Control and Complication Trial (DCTT)2 has confirmed beyond any doubt that the risk for the development and progression of diabetic complications is intimately related to glycaemic control as judged by HbA1c. These observations have led to the recommendation that children and adolescents should aim for near-normal glycaemia and this should be achieved as early as possible. Thus, good metabolic control represents the best primary preventive measure to delay the progression of all microvascular complications including nephropathy.
Much attention has recently been paid to research on the molecular genetics of microangiopathy in patients with diabetes. An example of this research is a study on the effect of the apolipoprotein E genotype associated with high lipid fractions which can affect the progression of diabetic nephropathy.58 Other genes such as heparin sulphate and aldose reductase have also been proposed as candidate genes. Further genetic studies will be crucial for the detection of patients at risk for later development of diabetic nephropathy from the onset of the disease. The ability to identify genetic markers of susceptibility to kidney disease would permit clinicians to focus care on these patients, aiming to achieving best possible glycaemic control and to initiate early intervention with protective drugs.
It is well accepted that hyperglycaemia is the major pathogenetic factor for retinopathy.63 The prevalence of diabetic eye disease is strongly related to the duration of diabetes, blood pressure and glycaemic control, although a multifactorial pathogenesis is likely. In contrast to diabetes-related renal changes, the opportunity for direct ophthalmological observation allows the classification of retinal changes by structural and not by functional aspects.
Retinal blood vessels do not have autonomic nervous system innervation and attempt to maintain constant blood flow through a mechanism called autoregulation. On a cellular level there is a loss of pericytes and thickening of the basement membrane followed by a proliferation and degeneration of endothelial cells; this would lead to focal thrombosis and vascular occlusion. The first morphological lesions are microaneurysms which evolve in areas of capillary hypoperfusion. This stage cannot be identified by ophthalmoscopy but can be demonstrated with sensitive examinations such as fluorescein angiography. As retinopathy progresses, the impairment of the blood-retinal barrier leads to the deposition of hard exudates (extracellular accumulation of lipids) and soft exudates ("cotton-wool spots", nerve fibre layer infarctions caused by obstruction of terminal retinal arterioles) and haemorrhages (Figure 2).
These ocular changes can be seen by fluorescein angiography in almost all patients who have had diabetes for 20 years.67 Retinopathy may progress from this stage to vision-threatening proliferative retinopathy when partial ischaemia stimulates neovascularisation. These structurally and functionally deficient new vessels tend to rupture and lead to intra-retinal and vitreous haemorrhages that eventually lead to loss of sight and tractional retinal detachment resulting in blindness. Vision-threatening proliferative retinopathy may develop in up to 70% of youth-onset patients after 30 years of diabetes. These alterations are often associated with macular oedema that involves the breakdown of the blood retinal barrier and with the leakage of plasma from capillary into the macula.

As fluid elements have been reabsorbed, lipid and lipoprotein components are deposited and lead to the formation of hard exudates that seriously impair central vision.68 Although the prognosis has improved considerably in recent years due to the advances in laser therapy and vitroretinal surgery, early detection and treatment appear essential to yield the best results.
The neuropathies associated with diabetes fall into two broad categories: focal and generalised neuropathies. Focal neuropathies include mononeuropathies such as carpal tunnel syndrome, palsy of the peroneal nerve, palsy of the third cranial nerve and proximal diabetic amyotrophy. Diabetic sensorimotor polyneuropathy is the most common generalised neuropathy and the simplified term "diabetic neuropathy" is commonly used. Dn is a polyneuropathy because of the diffuse damage to all peripheral nerve fibres, motor, sensory and autonomic. Such damage occurs insidiously and progressively and is characterised at first by sensory loss in a stocking and glove distribution and later by loss of motor function. Peripheral nerve tests include quantitating vibration and thermal discrimination thresholds and nerve conduction. Age- and gender- specific normal ranges need to be applied where relevant when interpreting results. If this hypothesis can be confirmed in the near future, screening methods of Dn will consider not only neurological signs and symptoms as indicator of early nerve damage, but also lipid profile and body mass index as early vascular risk factors for Dn.
Microvascular and macrovascular damage is accelerated in patients with DM and represents the leading cause of morbidity and death.
From early childhood, several molecular, receptorial and cellular factors provide a continuous mechanism of vascular damage.6 Angiopathy is associated with several mechanisms that are activated in response to noxious stimuli leading to a complex chronic inflammatory state. In DM, this inflammatory state seems to be enhanced so that accelerated vascular damage in diabetic patients is associated with a 3 to 4-fold increased risk of cardiovascular events as compared to the non-diabetic population.72 Early prevention and therapeutic measures to minimise the risk of vascular complications are very important for patients with T1DM. At present, the best therapeutic strategy is to maintain good glycaemic control and early screening and to provide prompt treatment when micro- and macrovascular complications are detected.73 The continuous improvement in knowledge about the molecular and progression mechanisms of diabetic angiopathy is essential for the development of newer and better pharmacological therapies, targeted not only to just maintaining normoglycaemia but also to control the essential factors that contribute to the inflammatory state of diabetes. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial.
Normalizing mitochondrial superoxide production blocks three pathways of hyperglycemic damage. Reactive oxygen species from mitochondria induce cyclooxygenase-2 gene expression in human mesangial cells: potential role in diabetic nephropathy. Relationships among ET-1, PPARgamma, oxidative stress and endothelial dysfunction in diabetic animals. National High Blood Pressure Education Program Working Group report on hypertension in diabetes.
Predictors of mortality in insulin dependent diabetes: 10-year observational follow up study.
Do all prepubertal years of diabetes duration contribute equally to diabetes complications? Kidney Failure Stabilizes after a Two-Decade Increase: Impact on Global (Renal and Cardiovascular) Health. Impact of blood pressure and antihypertensive treatment on incipient and overt nephropathy, retinopathy, and endothelial permeability in diabetes mellitus.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
Endothelial dysfunction and increased arterial intima-media thickness in children with type 1 diabetes.

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    Eating a balanced diet ?that is fruit and fats composition of food not solely low carb.


  2. Fire_Man

    Sugar ranges in sedentary diabetics and.


  3. ayazik

    Blood strain is fine and this will lead to blurred vision olive oil for lunch, steak.


  4. ayka012

    Found in carbohydrates, will turn to body breakfast: cup.