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DIABETIC RETINOPATHY Diabetic retinopathy is a frequent cause of blindness. The exact cause of diabetic microvascular disease is unknown.

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Presentation on theme: "DIABETIC RETINOPATHY Diabetic retinopathy is a frequent cause of blindness. The exact cause of diabetic microvascular disease is unknown."— Presentation transcript:

1 DIABETIC RETINOPATHY Diabetic retinopathy is a frequent cause of blindness. The exact cause of diabetic microvascular disease is unknown.

2 Etiology Glicosylation of tissue proteins causes cell damage Glicosylation of tissue proteins causes cell damage Aldose reductase results in an accumulation of intracellular sorbitol which causes basement membrane thickening and damages pericytes Aldose reductase results in an accumulation of intracellular sorbitol which causes basement membrane thickening and damages pericytes Hyperglycemia can cause overactivation of proteinkinase CB, PKCB is now recognized as a key factor in the underlying process of mirovascular damage that leads to dibetic retinopathy and diabetic macular edema Hyperglycemia can cause overactivation of proteinkinase CB, PKCB is now recognized as a key factor in the underlying process of mirovascular damage that leads to dibetic retinopathy and diabetic macular edema

3 DIABETIC RETINOPATHY classificatin Background diabetic retinopathy Background diabetic retinopathy Preproliferative diabetic retinopathy Preproliferative diabetic retinopathy Proliferative diabetic retinopathy Proliferative diabetic retinopathy Macular edema Macular edema

4 Risc factors in the development of diabetic retinopathy Long duration of diabetes Long duration of diabetes Poor metabolic control Poor metabolic control Pregnancy Pregnancy Hypertension Hypertension Renal disease Renal disease Obesity Obesity Hyperlipidaemia Hyperlipidaemia Smoking Smoking Anaemia Anaemia

5 Microaneurysms usually temporal to fovea Intraretinal dot and blot haemorrhages Hard exudates Signs of background diabetic retinopathy

6 Cotton-wool spots Venous irregularities Dark blot haemorrhages Intraretinal microvascular abnormalities (IRMA) Signs Preproliferative diabetic retinopathy

7 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 retinopathy

8 Diabetic macular edema Diabetic macular edema manifest as focal or diffuse retinal thickening with or without exudates. Diabetic macular edema manifest as focal or diffuse retinal thickening with or without exudates. This is the main cause of the decrease of central vision in nonproliferativ diabetic retinopathy This is the main cause of the decrease of central vision in nonproliferativ diabetic retinopathy

9 Complication of proliferative diabetic retinopathy Vitreous hemorrhage Preretinal hemorrhage Progressive proliferation Tractional retinal detachment

10 Other complication of DR Fluctuation in refraction Fluctuation in refraction Diabetic cataract Diabetic cataract Isolated cranial nerve palsies (3, 4, 6) Isolated cranial nerve palsies (3, 4, 6) Neuroopticopathy Neuroopticopathy Neovascular glaucoma Neovascular glaucoma

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

12 Symptoms Early stages of diabetic retinopathy often don't have symptoms Early stages of diabetic retinopathy often don't have symptoms As the disease progresses, diabetic retinopathy symptoms may include: As the disease progresses, diabetic retinopathy 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.

13 Causes of vision loss in proliferative diabetic retinopathy Vitreous hemorrhage Vitreous hemorrhage Tractional retinal detachment Tractional retinal detachment Neovascular glaucoma Neovascular glaucoma

14 Advansed diabetic retinopathy is associated with: Cardiovascular risk factors Cardiovascular risk factors Heart attack Heart attack Stroke Stroke Diabetic nephropathy Diabetic nephropathy Amputation Amputation Death Death

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

16 Treatment Laser photocoagulation (focal / panretinal). Laser photocoagulation (focal / panretinal). Indication: macular edema, preproliferative and proliferative retinopaty, rubeosis, neovascular glaucoma Indication: macular edema, preproliferative and proliferative retinopaty, rubeosis, neovascular glaucoma

17 Treatment Vitreoretinal surgery Vitreoretinal surgeryindication: Noncliaryng vitreous hemorrhage, Noncliaryng vitreous hemorrhage, tractional retinal detachment, tractional retinal detachment, progressivee fibrovascular proliferation progressivee fibrovascular proliferation

18 Eye examination – how often At the time of initial diagnoses At the time of initial diagnoses Normal retina or rare microaneurismus – annually Normal retina or rare microaneurismus – annually Moderate nonproliferative retinopathy - every 6 months Moderate nonproliferative retinopathy - every 6 months Preproliferative/ proliferative retinopathy, macular edema – every 2-4 months Preproliferative/ proliferative retinopathy, macular edema – every 2-4 months Pregnancy – before pregnancy, each trimester and 3-6 months postpartum Pregnancy – before pregnancy, each trimester and 3-6 months postpartum

19 Catedra Oftalmologie Conf. univ. A. Corduneanu


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