Diabetic disease[1]


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Diabetic disease[1]

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