Upload
confusionexpert1
View
17
Download
0
Embed Size (px)
Citation preview
YOUSAF ALIYOUSAF ALI
LECTURER(DOCTOR OF LECTURER(DOCTOR OF OPTOMETRY)OPTOMETRY)
Objectives of Objectives of presentationpresentation
Diabetes is one of the global health Diabetes is one of the global health challenges, affecting about 3 % challenges, affecting about 3 % population of the world.population of the world.
Diabetic ophthalmopathy – a Diabetic ophthalmopathy – a common, sight-threatening common, sight-threatening complication of diabetes. complication of diabetes.
DIABETES MELLITUS:
TYPE 1 (IDDM) ------- Insulin dependent diabetes mellitusTYPE 2 (NIDDM) ---- Non Insulin dependent diabetes mellitus
SYSTEMIC EFFECTS OF DIABETES
STROKE
CORONARY ARTERY DISEASENEPHROPATHY
PERIPHERAL VASCULAR DISEASEPERIPHERAL NEUROPATHY
DIABETIC DIABETIC OPHTHALMOPATHYOPHTHALMOPATHY
EXTRA RETINAL EFFECTS OF
DIABETES ON EYE
LidsStyesChalazionXanthelasmas
Lens
Cataract
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
CorneaKeratitisRecurrent corneal erosionPersistent epithelial defects
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Refractive ErrorOsmotic swelling of lens causes myopic shift.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Glaucoma
Angle closure glaucoma
Neovascular glaucoma
Blood associated glaucoma
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Vitreous humor
Asteroid hyalosis
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Occlusive retinal vascular diseases
CRAOCRVOBRAOBRVO
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
CRVO
BRVO
BRAO
CRAO
OPTIC NERVE
Acute disc oedema Mild acute AION Optic nerve hypoplasia Optic atrophy
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Cranial nerve palsies
Focal small vessel occlusion & ischaemic demyelination---- cause
Occulomotor Trochlear
& Abducent nerves palsies.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
3RD NERVE PALSY
Infectious diseases
ENDOPHTHALMITIS MUCORMYCOSIS cause internal and external ophthalmoplegia, Proptosis, ptosis. HERPES ZOSTER INFECTION may affect the trigeminal nerve. Cause Uveities and keratits.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
Diabetic Diabetic RetinopatRetinopathyhy
TYPES OF DIABETES MELLITUS AND
OCULAR INVOLVEMENT
Diabetic RetinopathyType 1 Diabetics 40%Type 2 Diabetics 20%
Diabetic Retinopathy
EPIDEMIOLOGY
Prevalence increases with duration of diabetes & age. After 20 years of diabetes, 99% pts with IDDM & 60% with NIDDM—have some degree of retinopathy. 70-80 million people affected worldwide. 5-8% population of Pakistan is affected. 5-10% of all diabetics have sight-threatening retinopathy.
CLINICAL CLASSIFICATION OF DRDisease Severity Scale
• No Retinopathy • NPDR
MildModerate Severe
• PDR• ADED• EDED
AMERICAN ACADEMY OF OPHTHALMOLOGY
RISK FACTORS
Onset / Duration of Diabetes:
DM before 30yrs of age —----
incidence 50%
DM after 10yrs ----- incidence
90% Type of Diabetes ( IDDM --- 40%,
NIDDM-----20%) Age -----higher risk of PDR in younger
diabetics. Sex ------Men with IDDM have ↑ risk of
developing PDR.
Diabetic Control Nephropathy Hypertension Hyperlipidemias Cigarette smoking Pregnancy
RISK FACTORSCONT’D
DIABETIC MICROANGIOPATHY
High Blood Sugar
COMPLICATIONS:• Ocular / Retinal• Renal• Neuropathic• Peripheral Vascular
Capillary Leakage Capillary Closure
Structural damage &Functional failure
Pathogenesis of diabetic retinopathy
Consequences of retinal ischaemia
Consequences of chronic leakage
BGDR CLINICAL FEATURES
Micro-aneurysm Intra retinal haemorrhages Hard exudates Retinal oedema
Micro-aneurysm
Intra retinal haemorrhages
Hard exudates Retinal oedema
MANAGEMENT (BGDR)
Proper diabetic control Proper management of hypertension, anaemia and renal disease. Observations for
Maculopathy Ischaemia New vessels
DIABETIC MACULOPATHY
“Involvement of fovea by oedema & hard exudates
or Ischaemia.”
MACULOPATHY
Focal Diffuse Ischaemic Mixed
Focal diabetic maculopathy
Diffuse diabetic maculopathy
Ischemic diabetic maculopathy
Mixed Maculopathy
PRE-PROFLIFERATIVE DR
CLINICAL FEATURES Large blot haemorrhages Venous changes--- dilatation, beading, looping IRMA Capillary non-perfusion
MANAGEMENT Close observation Laser on progression
Preproliferative diabetic retinopathy
PROLIFERATIVE DR
NVDNVEVitreous/Pre-retinal
hemorrhage
Proliferative diabetic retinopathy
Neovascularization of disc = NVD
• Affects 5-10% of diabetics
• IDDM at increased risk (60% after 20 years)
Neovascularization elsewhere = NVE
NVD NVD + NVE
LASER TREATMENT FOR PDR
Neo-vascularization in DR
Principle of PRP
PRP
ADVANCED DIABETIC EYE DISEASE
Persistent new vessels Tractional retinal detachment Neovascular glaucoma
Persistent new vessels
Tractional RD
Neo-vascular Glaucoma
END STAGE DIABETIC EYE DISEASE
Phthisical eye
INDICATIONS FOR VITREO-RETINAL SURGERY
Retinal detachment involving macula
Severe persistent vitreous haemorrhage
Dense, persistent premacular haemorrhage
Progressive proliferation despite laser therapy
PPV for DR
FOR YOUR TIME & ATTENTION