Diabetic disease[1]
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Diabetic disease[1]






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Diabetic disease[1] Diabetic disease[1] Presentation Transcript

  • Diabetic eye disease Dr Ho Sze Yuen FHKAM (Ophthalmology)
  • Important facts
    • Risk of blindness is 25 times greater in diabetic than is non-diabetics
    • The incidence of DR is related more to the duration of diabetes than to any other factor.
    • In patients diagnosed as diabetic prior to the age to 30 years,
    • 50% DR after 10 years
    • 90% DR after 30 years
  • Background diabetic retinopathy
  • Pathogenesis
    • Microangiopathy affecting the arterioles, capillaries, venules
    • Microvascular occlusion and leakage.
  • Pathology of microvascular leakage
    • breakdown of basement membrane of capillaries
  • Consequences of microvascular leakage
    • Increased vascular permeability
    • Retinal heamorrhage and oedema
  • Circinate ring
  • Circinate ring laser
  • Pathology of microvascular occlsuion
    • Ischeamia of retina
    • Stimulate aniogenic factor
    • Proliferation of new vessels
    • Bleed from new vessels
  • Consequences of microvascular occlusion
    • Microvascular occlusion
    • hyopoxic retina
    • vasoformative substnace
    • Neovascularization
  • Proliferative diabetic retinopathy
  • Preliferatibe diabetic retinopathy
  • Proliferative diabetic retinopathy
  • Proliferative diabetic retinopathy
  • Pre-retinal haemorrhage
  • Recommendation
    • Annual check of retina, either by GP or ophthalmologist
  • When to refer
    • When you see pathology, not to wait until vision drops
    • Vision is normal in background diabetic retinopathy, until macular edema
    • Vision is normal in proliferative diabetic retinopathy, with new vessels until vitreous haemorrhage
  • Fluorescein angiography procedure
  • Fluorescein angiogram
  • Fluorescein angiogram
  • Pan-retinal phtocoagulation(PRP)
  • Laser application
  • Proliferative diabetic retinopathy after PRP
  • Tractional retinal detachment
  • Advanced tractional retinal detachment
  • Indications for laser
    • Macular edema
    • Proliferative diabetic retinopathy
  • Circinate ring
  • Circinate ring laser
  • Effects of macular laser
    • seal off the leaking vessels,
    • Prevent further leakage,
    • The existing edema needs 2-3 months to be absorbed
    • Since scars are induced by laser, the vision may drop a little bit after laser,
    • The result may sacrifice some vision, to attain a stable vision in future
  • Effects of laser for new vessels, pan-retinal photocoagulation (PRP)
    • To ablate the peripheral normal retina, and save the central part
    • Aim is to decrease the nutrient demand, the residual nutrient can concentrate to the central retina
    • Patient may feel dim or blur of peripheral field
  • Pan-retinal phtocoagulation(PRP)
  • Conclusion
    • Diabetic retinopathy is more likely in patients with long history of DM, or poor control
    • Diabetic retinopathy is generally a downhill disease
    • Laser is the only treatment to decrease the rate of deterioration or stabilize the condition
  • Conclusion
    • If vitreous heamorrhage occurs, laser cannot penetrate the haemorrhage and aim on the retinal pathology, the surgery is indicated to aspirate the haemorrhage
    • To prevent complication is better than to treat
    • To treat early is better than to treat late