Diabetic thy by Dr. Mostafa Zahir Raihani

8/3/2019 Diabetic thy by Dr. Mostafa Zahir Raihani

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DIABETIC RETINOPATHY

PRESENTED

BY

DR.MOSTAFA ZAHIR RAIHANI

EYE SPECIALIST



Diabetic retinopathy is a complication of diabetes thatis caused by changes in the blood vessels of the retina.

When blood vessels in the retina are damaged, they mayleak blood and grow fragile, brush-like branches andscar tissue.

This can blur or distort the vision images that the retinasends to the brain.





















P h i f di b i



Micro-vascularocclusion

Micro-vascularleakage

Pathogenesis of diabetic

retinopathy

Mi l



Micro-vascularocclusion

C f ti l i h i



Consequences of retinal ischaemia



MICROVASCULAR LEAKAGE

PATHOGENESIS :

BREAK DOWN OF INNER BLOOD

RETINAL BARRIER

MICROANEURYSMS

CONSEQUENCE:

DIFFUSE RETINAL OEDEMA

LOCALIZED RETINAL OEDEMA

Micro vascular leakage & it



Micro-vascular leakage & its

Consequences



RISK FACTORS :

DURATION OF DM

POOR METABOLIC CONTROL

PREGNANCY

HYPERTENSION

NEPHROPATHY

OTHERS:

OBESITY

SMOKING

HYPERLIPIDAEMIA





Based on dilated fundus examination



Signs of background diabetic retinopathy



Signs of background diabetic retinopathy

Microaneurysms usually

temporal to foveaIntraretinal dot andblot haemorrhages

Hard exudates frequentlyarranged in clumps or rings

Retinal oedema seen asthickening on biomicroscopy

Location of lesions in



Location of lesions in

backgrounddiabetic retinopathy



Focal diabetic maculopathy

• Circumscribed retinal thickening

• Associated complete or incompletecircinate hard exudates

• Focal leakage on FA

•

Focal photocoagulation• Good prognosis



Diffuse diabetic maculopathy

• Diffuse retinal thickening • Generalized leakage on FA

• Guarded prognosis• Grid photocoagulation• Frequent cystoid macular oedema

• Variable impairment of visual acuity



Ischaemic diabetic maculopathy

• Macula appears relatively normal • Capillary non-perfusion on FA

• Poor visual acuity • Treatment not appropriate

Clinically significant macular oedema



Clinically significant macular oedema

Hard exudateswithin 500 m

of centre of fovea with adjaceoedema which mabe outside 500 mlimit

Retinal oedema one disc area or larger anypart of which is within one disc diameter(1500 m) of centre of fovea

Retinal oedemawithin 500 mof centre of fovea

Preproliferative diabetic retinopathy



Preproliferative diabetic retinopathy

• Cotton-wool spots

• Venous irregularities

• Dark blot haemorrhages

• Intraretinal microvascularabnormalities (IRMA)

Signs



Cotton wool spotsRepresent focalinfarcts of the

retinal NFL, due toocclusion of pre-capillary arterioles.

Small whitish,fluffy superficial

lesions whichobscureunderlying bloodvessels.



IRMA

Represent shunts that run fromretinal arterioles to venules thus

by passing the capillary bed.

Seen adjacent to areas of capillaryclosure.



Dark blot hemorrhage

Represent hemorrhagic retinalinfarcts

Located within the middle retinal

layers.



Beading

Venous looping



Treatment - not required

but watch for

proliferative disease

Preproliferative diabetic

retinopathy

Proliferative diabetic retinopathy



p y

• Flat or elevated

• Severity determined by comparing with area of disc

Neovascularization

Neovascularization of disc = NVD

• Affects 5-10% of diabetics• IDD at increased risk (60% after 30 years)

Neovascularization elsewhere = NVE







Laser panretinal photocoagulation



•

•Spot size (200-500 m) dependson contact lens magnification

•Gentle intensity burn (0.10-0.05 sec)

•Follow-up 4 to 8 weeks

•Area covered by complete PRP

•Initial treatment is 2000-3000 burns

Assessment after photocoagulation



• Persistent neovascularization

• Haemorrhage

Poor involution

• Re-treatment required

• Regression of neovascularization

• Residual ‘ghost’ vessels orfibrous tissue

Good involution

• Disc pallor



50% stable of Vision

50% decreased of vision



If PDR not treated by PRP complicationsdevelops



Advanced Diabetic eye

disease

Serious vision threatening

complication of DR.



Pre-retinalhemorrhage



Tractional retinal



Tractional retinaldetachment





Opaque membrane



Opaque membrane





Rubeosis iridis



Advanced Diabetic eye disease treatmentis mainly vitreoretinal surgery



Surgery often slows or stops the progression of diabetic

retinopathy, but it's not a cure. Because diabetes is a

lifelong condition, future retinal damage and vision loss ispossible.

Even after treatment for diabetic retinopathy, patient need

regular eye exams. So there is safe pathway of management is……………………..



People with type 1 or type 2 diabetes should have adilated eye exam every year. The American DiabetesAssociation (ADA) recommends that anyone who'sover 10 years old with type 1 diabetes have his or herfirst eye exam within five years of being diagnosedwith diabetes. For people with type 2 diabetes, theADA advises getting the initial eye exam soon afterdiagnosed with diabetes, because may have haddiabetes for some time without knowing it.



Women with diabetes who become pregnant need tohave an eye exam during the first trimester ofpregnancy and possibly again later in the pregnancy,depending on the results of the first exam. The reasonfor this is that pregnancy can sometimes worsendiabetic retinopathy.



Patient of diabetes, reduce risk of getting diabeticretinopathy by doing the following:

Make a commitment to managing diabetes. Makehealthy eating and physical activity part of daily

routine. Take oral diabetes medications or insulin asdirected.



Monitor blood sugar level. Patient need to checkand record blood sugar level as requered—morefrequent measurements may be required if patientare ill or under stress.

Careful monitoring is the only way to make sure thatblood sugar level remains within target range.



Glycosylated hemoglobin test. The glycosylatedhemoglobin test or hemoglobin A1C test reflectsaverage blood sugar level for the two- to three-monthperiod before the test. For most people, the HbA1Cgoal is to be under 7 percent. Perform this test twice ayear. But, if it is higher than goal, more frequenttesting is recommended. So, blood sugar level as closeto normal as possible slows the progression ofdiabetic retinopathy and reduces the need for

surgery.



Keep blood pressure and cholesterol under control. High blood pressure and high cholesterol increase therisk of vision loss. Eating healthy foods, exercisingregularly and losing excess weight can help.Sometimes medication is needed, too.



Stop smoking & other types of tobacco.

Pay attention to vision changes. Urgent contact toeye doctor right away if experience sudden vision

changes or vision becomes blurry, spotty or hazy.



Diabetes doesn't necessarily lead to poor vision.Taking an active role in diabetes management can go along way toward preventing complications



Thanks

for attention

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Diabetic thy by Dr. Mostafa Zahir Raihani