| Diabetic retinopathy results
from the effects of diabetes on blood vessels in the
retina, the tissue which lines the inner eye. Diabetes
causes retinal blood vessels to leak and grow abnormally. |
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| Diabetic retinopathy is the
most common of cause of legal blindness in individuals
between the ages of 20 and 65 years. |
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| Risk factors in Diabetic
Retinopathy |
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| Duration of diabetes is the
most important factor, the incidence of Diabetic retinopathy
after 10 years is 50% and after 30 years 90%. |
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| Poorly controlled patients
develop diabetic retinopathy sooner than those who are
well controlled. |
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| Other risk factors include
Pregnancy, Hypertension, Renal disease, Smoking |
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| Types of Diabetic Retinopathy |
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| Simple Background Diabetic
Retinopathy |
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| Diabetic Maculopathy |
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| Pre-Proliferative Diabetic
Retinopathy |
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| Proliferative Diabetic Retinopathy |
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| Advanced Diabetic eye disease |
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| Simple Background Diabetic
Retinopathy |
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Usually patients are asymptomatic
Retinal examination shows |
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| Micro
aneurysms |
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| Intraretinal
haemorrhages |
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| Hard
exudates |
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| Retinal
oedema |
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| Treatment |
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| Usually do not require laser
treatment |
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|
|
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| Advised : |
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| Periodic retinal
examination |
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| DIABETIC MACULOPATHY |
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| Involvement of the fovea
(central part of the retina) is the most common cause
of visual impairment in diabetic patient. |
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| Types |
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| Focal Maculopathy |
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| Diffuse Maculopathy |
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| Ischaemic Maculopathy |
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| Mixed Maculopathy |
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| Clinically significant macular
oedema |
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|
|
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| Treatment |
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| All eyes with Clinically
significant macular oedema should be considered for
treatment with laser photocoagulation irrespective of
the level of visual acuity because treatment reduces
the risk of visual loss by 50%. |
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| PRE-PROLIFERATIVE DIABETIC
RETINOPATHY |
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| Preproliferative Diabetic
Retinopathy develops in some eyes which initially show
only simple background diabetic retinopathy. All the
clinical lesions are caused by retinal ischemia. |
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| Types |
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| Vascular changes |
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| Cotton wool spots |
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| Dark blot haemorrhage |
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| Intraretinal microvascular
abnormalities. |
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|
|
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| Treatment |
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| Patients are watched closely
because a significant number develop proliferative diabetic
retinopathy. Laser photocoagulation is advised depending
on the severity of the retinopathy. |
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| PROLIFERATIVE DIABETIC RETINOPATHY |
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| Proliferative diabetic retinopathy
affects about 10% of the diabetic population. Patients
with IDD (Insulin Dependent Diabetes) are at increased
risk of PDR with an incidence of about 60% after 30
years. |
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| Clinical features |
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Neovascularization is the
hallmark of the Proliferative diabetic retinopathy.
Haemorrhage may occur into the vitreous gel |
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|
|
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| Treatment |
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| The aim of treatment by laser
photocoagulation is to induce involution of new vessels
and prevent vitreous haemorrhage. Initial treatment
involves the placement of about 2000 burns in a scattered
pattern. |
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| ADVANCED DIABETIC EYE DISEASE |
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| Serious vision threatening
complications of diabetic retinopathy occur in patients
who have not had laser therapy or in whom laser photocoagulation
has been unsuccessful or inadequate. One or more of
the following complications may occur. |
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| Persistent intragel vitreous
haemorrhage |
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| Tractional retinal detachment
|
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| Opaque membranes |
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| Rubeosis iridis |
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| Treatment |
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| Pars Plana Vitrectomy |
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| Symptoms |
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| There are two main stages
of diabetic retinopathy: non-proliferative and proliferative.
In non-proliferative diabetic retinopathy, patients
may have normal vision. The damaged retinal vessels
leak fluid. Fat and protein particles may leak from
these vessels and become deposited in the retina in
patches known as retinal exudates. The retinal blood
vessels may bleed into the retina and result in tiny
hemorrhages. If any of the leaky fluid accumulates in
the central part of the retina (called the macula),
the vision is affected. This condition is called macular
edema.
In proliferative diabetic
retinopathy, patients grow new abnormal blood vessels
which extend over the surface of the retina. These
vessels occasionally invade the gelatinous contents
of the eye, the vitreous. The proliferating blood
vessels frequently break, causing vitreous bleeding
that may significantly decrease vision. Fibrous tissue
may grow over the new blood vessels and distort vision.
Occasionally, the tissue may contract and pull the
retina off the inner surface of the eye, causing a
tractional retinal
detachment.
|
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| Photograph of proliferative
diabetic retinopathy |
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| Treatment |
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The best treatment is prevention.
Strict control of blood sugar levels slows the development
and progression of diabetic retinopathy.
Pre-proliferative and proliferative diabetic retinopathy
may be treated with laser
photocoagulation.
Macular edema ( collection of fluid in the central part
of the retina) may
also be treated with laser therapy.
Advanced proliferative diabetic retinopathy with vitreous
haemorrhage needs vitreous surgery. |
