Rheohemapheresis May Be Successful

Diabetic Retinopathy: Early Diagnosis and Effective Treatment by Dr. med. Aris N. Kollias, Prof. Dr. med. Michael W. Ulbig in volume 5/2010

The authors correctly write that diabetic retinopathy is a microangiopathy of the retina with changes to the vascular walls and the rheological properties of blood. However, they omitted to mention a particular therapeutic approach that has been used to treat diabetic retinopathy for many years (1).

The rheological properties of blood are primarily determined by the number of erythrocytes. The packed cell volume should be lowered if patients tolerate this without developing problems. Further, blood rheology is determined by plasma proteins, which can be eliminated by means of apheresis technology. Rheohemapheresis has been used successfully for many years to improve the rheological properties of blood, not only in diabetic retinopathy but also in the treatment of other diabetes related complications. In diabetic foot syndrome, for example, apheresis therapy has been shown to accelerate wound healing and helped avoid amputations (2).

Apheresis technology has also been used to treat all pathologies that are caused by impaired blood viscosity or microcirculation (3).

Rheohemapheresis is a safe therapeutic option that imposes a minimal burden on the patient. If the indication is defined correctly, it can complement the therapeutic modalities described by the authors and can delay vision loss in diabetic retinopathy. The positive effects on rheology apply not only locally but also systemically.

The costs of outpatient rheohemapheresis therapy are usually not covered by statutory health insurance companies.

DOI: 10.3238/arztebl.2010.0444c

Jürgen Otto

Knippmühle 14

52249 Eschweiler-Nothberg, Germany

Conflict of interest staement

The author declares that no conflict of interest exists according to the Guidelines of the International Committee of Medical Journal Editors.

References

1. Lüke C, Widder RA, Soudavar F, Walter P, Brunner R, Borberg H: Improvement of macular function by membrane differential filtration in diabetic retinopathy. Journal of Clinical Apheresis 2001; 16: 23–8.

2. Klingel R, Mumme C, Fassbender T et al.: Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial. Therapeutic Apheresis and Dialysis 2003; 7: 444–55.

3. Borberg H, Tauchert M: Rheohaemapheresis of ophtalmological diseases and diseases of the microcirculation. Transfusion and Apheresis Science 2006; 34: 41–9.

4. Kollias AN, Ulbig MW: Diabetic retinopathy: early diagnosis and effective treatment [Diabetische Retinopathie: Frühzeitige Diagnostik und effiziente Therapie]. Dtsch Arztebl Int 2010; 107(5): 75–84.