Download - Diabetic retinopathy (opthalmology)
B Muhd Ariff Mahdzub
DIABETIC RETINOPATHY
DIABETIC RETINOPATHY
Retinal changes as a complication of or due to
diabetes mellitus (DM)
• In Malaysia, diabetic eye disease is the commonest cause of visual loss among adults of working age
• Prevalence is closely-related to duration of diabetes• At diagnosis of DM, prevalence is only less than 5% but
after 10 years, it rises up to 40% – 50%• The risk factor includes duration of having diabetes, poor
glucose control, hypertension, obesity, and pregnancy.• Annual screening is recommended for diabetic patient for
early detection enabling well-planned treatment.
PATHOPHYSIOLOGY
Retinal ischemiaReduced blood flow, decreases of vascular endothelial retinal perfusion
Release vascular endothelial growth factor
New blood vessels grow and proliferate inside the retina and vitreous humor
However, these new blood vessels can easily rupture and bleed, cloud vision and damage retina
Fibrovascular proliferation occurs as part of healing process due to rupture vessels
Neovascular glaucoma occur if the new blood vessels grow in the anterior chamber
Tractional retinal detachment
Figure (i) Looping Figure (ii) Beading Figure (iii) Severe segmentation
Venous changes
Cotton wool
Neovascularization
Arises from the optic nerve head along the large vessels
CLASSIFICATION
SCREENING
FOLLOW UP• Diabetic persons should be screened at least
every 2 years• High risk individuals should be examined
annually which are– Individuals with longer diabetes duration– Individuals with poor glucose control– Individuals with poor blood pressure
control– Individuals with poor serum lipid control
• The examination should include– Visual acuity assessment (Snellen chart and
equivalent)– Fundus photography or dilated fundus
examination• Individuals with any signs of NPDR should be
examined at 6-12 months interval• Earlier follow-up may be required in those of /
with– High risk groups– Presence of renal complications– Progression of DR
REFERRAL CRITERIA• Individuals with any of the
criteria below should be referred to ophthalmologist– Any level of diabetic
maculopathy– Severe NPDR– Any PDR– Unexplained visual loss– If screening examination
cannot be done, including ungradable fundus photo
TREATMENT
• DR is reversible with early detection
• Laser photocoagulation is the standard practice for treating DR
• However, there are different types of treatment of DR based on its stages as shown in the table beside
TREATMENT (cont.)
• Laser photocoagulation– Widely used for early stages of proliferative retinopathy
• Sealing of leaking blood vessels• Treat macular edema• Halt neovascularization
• Vitrectomy– Removal and replacement of cloudy vitreous due to blood accumulation with
normal saline– Done in patients with proliferative diabetic retinopathy– Able to restore vision, specially effective for insulin-dependent diabetic
patient• Anti-VEGF therapy
– Multiple injections of anti-VEGF drugs used in combination with laser photocoagulation for diabetic macular edema