DIABETIC RETINOPATDIABETIC RETINOPATHYHY

Diabetic retinopathy is a frequent cause Diabetic retinopathy is a frequent cause of blindness. of blindness.

The exact cause of diabetic The exact cause of diabetic microvascular disease is unknown. microvascular disease is unknown.

Etiology Etiology

Glicosylation of tissue proteins causes cell Glicosylation of tissue proteins causes cell damagedamage

Aldose reductase results in an accumulation of Aldose reductase results in an accumulation of intracellular sorbitol which causes basement intracellular sorbitol which causes basement membrane thickening and damages pericytesmembrane thickening and damages pericytes

Hyperglycemia can cause overactivation of Hyperglycemia can cause overactivation of proteinkinase CB, PKCB is now recognized as a proteinkinase CB, PKCB is now recognized as a key factor in the underlying process of key factor in the underlying process of mirovascular damage that leads to dibetic mirovascular damage that leads to dibetic retinopathy and diabetic macular edemaretinopathy and diabetic macular edema

DIABETIC RETINOPATDIABETIC RETINOPATHYHYclassificatin classificatin

DIABETIC RETINOPATDIABETIC RETINOPATHYHYclassificatin classificatin

BBackground diabetic ackground diabetic rretinopatetinopathy hy PreproliferativPreproliferative e diabetic diabetic rretinopatetinopathy hy ProliferativProliferative e diabetic diabetic rretinopatetinopathy hy

Macular edema Macular edema

Risc factors in the development Risc factors in the development of diabetic retinopathyof diabetic retinopathy

• Long duration of diabetesLong duration of diabetes• Poor metabolic controlPoor metabolic control• PregnancyPregnancy• HypertensionHypertension• Renal diseaseRenal disease• ObesityObesity• HyperlipidaemiaHyperlipidaemia• SmokingSmoking• AnaemiaAnaemia

Microaneurysms usually temporal to fovea

Intraretinal dot and blot haemorrhages

Hard exudates

Signs of background diabetic Signs of background diabetic retinopathyretinopathy

• Cotton-wool spots• Venous irregularities

• Dark blot haemorrhages• Intraretinal microvascular abnormalities (IRMA)

Signs

Preproliferative diabetic Preproliferative diabetic retinopathyretinopathy

The presence of newly formed blood vessels or fibrous tissue arising from the retina or optic disc and extending along the inner surface of the retina or disc into vitreos cavity

Proliferative diabetic Proliferative diabetic retinopathy retinopathy

Diabetic macular edemaDiabetic macular edema

Diabetic macular edema Diabetic macular edema manifest as focal or diffuse manifest as focal or diffuse retinal thickening with or retinal thickening with or without exudates.without exudates.

This is the main cause of the This is the main cause of the decrease of central vision in decrease of central vision in nonproliferativ diabetic nonproliferativ diabetic retinopathyretinopathy

CComplicaomplicationtion of proliferative of proliferative diabetic diabetic retinopathyretinopathy

VVitreitreousous hhemoemorrrrhhageage

PPrereretinalretinal hhemoremorrhrhage age

PProgresrogresssiveive p proliferaroliferationtion

Tractional retinal detachment Tractional retinal detachment

Other complication of DROther complication of DR

Fluctuation in refractionFluctuation in refractionDiabetic cataractDiabetic cataract Isolated cranial nerve palsies (3, 4, 6)Isolated cranial nerve palsies (3, 4, 6)NeuroopticopathyNeuroopticopathyNeovascular glaucomaNeovascular glaucoma

Neovascular glaucomaNeovascular glaucoma

Anterior segment of the eye ischemia Anterior segment of the eye ischemia leads to neovascularisation of iris leads to neovascularisation of iris (rubeosis) and anterior chamber (rubeosis) and anterior chamber angle and increase intraocular angle and increase intraocular pressure. pressure.

Symptoms Symptoms

Early stages of diabetic retinopathy often don't have Early stages of diabetic retinopathy often don't have symptomssymptoms

As the disease progresses, diabetic retinopathy As the disease progresses, diabetic retinopathy symptoms may include:symptoms may include: Floaters - Spots, dots or cobweb-like dark strings floating in vision Floaters - Spots, dots or cobweb-like dark strings floating in vision Blurred vision;Blurred vision; Vision that changes periodically from blurry to clear;Vision that changes periodically from blurry to clear; Blank or dark areas in visual field of vision;Blank or dark areas in visual field of vision; Poor night vision;Poor night vision; Colors appear washed out or different;Colors appear washed out or different; Vision loss.Vision loss.

Causes of vision loss in Causes of vision loss in proliferative diabetic retinopathy proliferative diabetic retinopathy

Vitreous hemorrhageVitreous hemorrhageTractional retinal detachmentTractional retinal detachmentNeovascular glaucomaNeovascular glaucoma

Advansed diabetic retinopathy Advansed diabetic retinopathy is associated with:is associated with:

Cardiovascular risk factorsCardiovascular risk factorsHeart attackHeart attackStrokeStrokeDiabetic nephropathyDiabetic nephropathyAmputationAmputationDeath Death

Treatment Treatment

Intensive glycemic control Intensive glycemic control reduces early developing of reduces early developing of diabetic retinopathy and reduced diabetic retinopathy and reduced progression.progression.

Treatment Treatment

Laser photocoagulation Laser photocoagulation (focal / panretinal). (focal / panretinal).

Indication: macular edema, Indication: macular edema, preproliferative and preproliferative and proliferative retinopaty, proliferative retinopaty, rubeosis, neovascular rubeosis, neovascular glaucomaglaucoma

Treatment Treatment

Vitreoretinal surgery Vitreoretinal surgery

indication:indication:Noncliaryng vitreous hemorrhage, Noncliaryng vitreous hemorrhage, tractional retinal detachment,tractional retinal detachment,progressivee fibrovascular proliferationprogressivee fibrovascular proliferation

Eye examination – how often Eye examination – how often

At the time of initial diagnosesAt the time of initial diagnoses Normal retina or rare microaneurismus – annuallyNormal retina or rare microaneurismus – annually Moderate nonproliferative retinopathy - every 6 Moderate nonproliferative retinopathy - every 6

monthsmonths Preproliferative/ proliferative retinopathy, macular Preproliferative/ proliferative retinopathy, macular

edema – every 2-4 monthsedema – every 2-4 months Pregnancy – before pregnancy, each trimester and Pregnancy – before pregnancy, each trimester and

3-6 months postpartum3-6 months postpartum

Catedra OftalmologieCatedra Oftalmologie

Conf. univ. A. CorduneanuConf. univ. A. Corduneanu