Diabetes melitis & eye part 2 presentation at www.eyenirvaan.com

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Diabetes melitis & eye part 2 presentation at www.eyenirvaan.com

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Diabetes melitis & eye part 2 presentation at www.eyenirvaan.com

  1. 1. DIABETES MELLITUS & EYE – PART 2 Pradnya Gogate B. Optom, To view more presentations and articles, visit www.eyenirvaan.com
  2. 2. Diabetic retinopathy has four stages:  Background diabetic retinopathy  Pre-proliferative diabetic retinopathy  Proliferative diabetic retinopathy  Advanced diabetic eye disease To view more presentations and articles, visit www.eyenirvaan.com
  3. 3. Background diabetic retinopathy  Microaneurysms-  In inner nuclear layer  Appear as small, round, red dots  Hard exudates-  In outer plexiform and inner nuclear layer  Distributed in circinate pattern To view more presentations and articles, visit www.eyenirvaan.com
  4. 4. Background diabetic retinopathy  Flame shaped haemorrhages- follow the course of retinal nerve fiber layer  Dot-blot haemorrhages – within compact middle layers To view more presentations and articles, visit www.eyenirvaan.com
  5. 5. Background diabetic retinopathy To view more presentations and articles, visit www.eyenirvaan.com
  6. 6. Management of background diabetic retinopathy  Proper control of sugar level  Regular follow up To view more presentations and articles, visit www.eyenirvaan.com
  7. 7. Preproliferative diabetic retinopathy  Cotton wool spots (Soft exudates)  due to capillary occlusion in retinal nerve fiber layer and the subsequent build-up of transported material within the nerve axons causes white and opaque appearance  IRMA’S(Intra Retinal Microvascular Abnormalities)  Venous changes like dilatation, beading, looping and sausage-like segmentation  Arteriolar narrowing and may cause central retinal artery occlusion(CRAO)  large dark blot hemorrhages To view more presentations and articles, visit www.eyenirvaan.com
  8. 8. Preproliferative diabetic retinopathy To view more presentations and articles, visit www.eyenirvaan.com
  9. 9. Management Preproliferative diabetic retinopathy  Close follow up  Photocoagulation is usually unnecessary unless FFA shows extensive areas of peripheral capillary non-perfusion To view more presentations and articles, visit www.eyenirvaan.com
  10. 10. Proliferative diabetic retinopathy  Neovascularisation is hallmark of PDR  NVD(new vessels at disc)  More than one quarter of retina has to be non- perfused for NVD  NVE (new vessels elsewhere)  Starts as endothelial proliferations arising from veins  They pass through the defects in the ILM to lie in potential vitro-retinal space  Forms fibrovascular epiretinal membrane To view more presentations and articles, visit www.eyenirvaan.com
  11. 11. Proliferative diabetic retinopathy  Recurrent vitreous haemorrhages  Fibrovascular component becomes adherent to posterior vitreous and leaks plasma constituents  Contraction of vitreous results in elevation of blood vessels above the plane of retina  New vessels may regress if vitreous detaches completely at this stage  Pulling from Partially detached vitreous causes vitreous haemorrhage To view more presentations and articles, visit www.eyenirvaan.com
  12. 12. Proliferative diabetic retinopathy To view more presentations and articles, visit www.eyenirvaan.com
  13. 13. Proliferative diabetic retinopathy(FFA) To view more presentations and articles, visit www.eyenirvaan.com
  14. 14. Management proliferative diabetic retinopathy  Pan retinal photocoagulation(PRP)  Thousands(2000-3000) of spots are burned around the peripheral retina.  Destroys the ischemic retina, decreasing the angiogenic stimulus, leads to regression and even the complete disappearance of the new vessels.  side effects,  peripheral vision loss  decreased night vision (from the rod photoreceptor loss) To view more presentations and articles, visit www.eyenirvaan.com
  15. 15. Pan Retinal Photocoagulation(PRP) To view more presentations and articles, visit www.eyenirvaan.com
  16. 16. Early Treatment Diabetic Retinopathy Study Group (EDTRS) Non-Proliferative Diabetic Retinopathy Minimal NPDR Mild NPDR Moderate NPDR Severe NPDR Very Severe NPDR Proliferative Diabetic Retinopathy (PDR) Early PDR High Risk (HR) PDR To view more presentations and articles, visit www.eyenirvaan.com
  17. 17. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  Minimal NPDR  Presence of microaneurysms only  Mild NPDR  Microaneurysms plus one or more of the following:  Intra-retinal hemorrhages  Hard exudates away from the macula  CWS To view more presentations and articles, visit www.eyenirvaan.com
  18. 18. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  Moderate NPDR  Microaneurysms/ hemorrhages in at least one quadrant plus one or more of the following:  CWS  IRMA  Venous beading To view more presentations and articles, visit www.eyenirvaan.com
  19. 19. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  Severe NPDR  Any one of the following (4-2-1 rule):  Intra-retinal hemorrhages - severe, in 4 quadrants  Venous beading in 2 quadrants  Moderately severe IRMA in 1 quadrant To view more presentations and articles, visit www.eyenirvaan.com
  20. 20. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  Very Severe NPDR  Any two of the following:  Intra-retinal hemorrhages - severe, in 4 quadrants  Venous beading in 2 quadrants  Moderately severe IRMA in 1 quadrant To view more presentations and articles, visit www.eyenirvaan.com
  21. 21. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  Early PDR  One or more of the following:  NVD < ¼ DD  NVE without hemorrhage  Pre-retinal or vitreous hemorrhage and NVE < ½ DD without NVD To view more presentations and articles, visit www.eyenirvaan.com
  22. 22. Early Treatment Diabetic Retinopathy Study Group (EDTRS)  High Risk PDR  One or more of the following:  NVD > ¼ DD  NVD with hemorrhage  NVE > ½ DD with hemorrhage To view more presentations and articles, visit www.eyenirvaan.com
  23. 23. Advanced diabetic eye disease  Pre-retinal haemorrhage(boat-shaped haemorrhage)  Tractional retinal detachment  Pulling away of neurosensory retina from RPE by avascular or fibrovascular vitreous membranes.  Nonvascular glaucoma (90 days glaucoma) To view more presentations and articles, visit www.eyenirvaan.com
  24. 24. Management of Advanced diabetic eye disease  Pan Retinal Photocoagulation(PRP)  Three port pars plana vitrectomy  Involves removing the vitreous humor  replacing it with saline.  removes hemorrhaged blood, inflammatory cells, and other debris  removes any fine strands of vitreous attached to the retina to relieve traction  Endo-laser is done To view more presentations and articles, visit www.eyenirvaan.com
  25. 25. Three port pars plana vitrectomy To view more presentations and articles, visit www.eyenirvaan.com
  26. 26. Retinal Occlusive Diseases  Central Retinal Vein Occlusion (CRVO)  Branch Retinal Vein Occlusion (BRVO)  Central Retinal Artery Occlusion (CRAO)  Branch Retinal Artery Occlusion (BRAO) To view more presentations and articles, visit www.eyenirvaan.com
  27. 27. Optic Disc  Anterior Ischemic Optic Neuropathy  Diabetic Papillitis To view more presentations and articles, visit www.eyenirvaan.com
  28. 28. Anterior Ischemic Optic Neuropathy(AION)  Interference with the posterior cilliary artery supply to anterior part of optic disc  Sudden painless loss of vision  Altitudinal field defect  Swelling of optic disc  Flame shaped hemorrhages To view more presentations and articles, visit www.eyenirvaan.com
  29. 29. Diabetic Papillopathy  Mild to moderate visual loss  Ranges from mild disc swelling without haemorrhages to  Florid swelling with capillary telangeiectesis, nerve fiber haemorrhages, exudates, CME with or without macular star  Treatment  Good diabetic control To view more presentations and articles, visit www.eyenirvaan.com
  30. 30. Diabetic Papillopathy To view more presentations and articles, visit www.eyenirvaan.com
  31. 31. Glaucoma  Primary open angle glaucoma(POAG)  Neovascular glaucoma(NVG) To view more presentations and articles, visit www.eyenirvaan.com
  32. 32. Cranial nerves  III, IV,VI,VII  III is the commonest affected To view more presentations and articles, visit www.eyenirvaan.com
  33. 33. Role of optometrists  Screening and counseling of patients  Referring the patient to ophthalmologist for investigations and treatment  Referring the patient to diabetologist for diabetes control  Prescribing the appropriate low vision devices,if required To view more presentations and articles, visit www.eyenirvaan.com
  34. 34. References  www.TheRetinasource.com  www.eyecare.htm  www.TimRoot.htm  www.TheMaculaCenter.com  www.mrcophth.com To view more presentations and articles, visit www.eyenirvaan.com

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