IN THE NAME OF GOD Gholamali Naderian MD Isfahan University Of
Medical Sciences Feiz Eye Center
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DIABETIC RETINOPATHY EPIDEMIOLOGY RISK FACTORS PATHOGENESIS
CLINICAL FEATURES CLASSIFICATION MANAGEMENT
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Diabetic Retinopathy Epidemiology Two forms of diabetes are
recognised: - Type 1 or juvenile-onset or insulin dependent - Type
2 or adult onset or non-insulin dependent One of the leading causes
of blindness in ages 20 - 74 90% of patients with diabetes have
type 2 diabetes
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Prevalence of Diabetic Retinopathy Type 1 diabetes - 71% Type 2
diabetes (not on insulin) - 39% Type 2 diabetes (on insulin) - 70%
Wisconsin Epidemiological Study of Diabetic Retinopathy
(WESDR)
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Adverse Risk Factors 1. Long duration of diabetes Obesity
Hyperlipidaemia 2. Poor metabolic control 3. Pregnancy 4.
Hypertension 5. Renal disease 6. Other Smoking Anaemia
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PATHOGENESIS
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Pathogenesis Microangiopathy which has features of both
microvascular leakage and occlusion Larger vessels may also be
involved
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Pathogenesis Microvascular occlusion The changes leading to
occlusion are: basement membrane thickening, endothelial cell
damage deformed RBCs causing decreased oxygen transport changes in
platelets leading to increased stickiness and aggregation
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Pathogenesis of diabetic retinopathy
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Pathogenesis Microvascular leakage Reduction in the number of
pericytes resulting in capillary wall distention producing
microaneurysms Breakdown of blood-retinal barrier results in
leakage of plasma constituents into the retina
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Consequences of chronic leakage
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Pathogenesis Microvascular occlusion Capillary non-perfusion,
retinal ischaemia and retinal hypoxia Production of vasogenic
factors like Vascular Endothelial Growth Factor(VEGF) VEGF
stimulates the growth of shunt and new vessels
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Consequences of retinal ischaemia
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Location of lesions in background diabetic retinopathy