This presentation describes how to manage diabetic retinopathy in a summarized manner

1. Diabetic
Retinopathy
By
Dr. Amr Mounir
Lecturer of ophthalmology
Sohag University

2. Diabetic retinopathyDiabetic retinopathy::
Diabetic microangiopathy whichDiabetic microangiopathy which
affects retinal vasculature with itsaffects retinal vasculature with its
complicationscomplications

3. Diabetic RetinopathyDiabetic Retinopathy
 Diabetic retinopathy is divided intoDiabetic retinopathy is divided into
1)1) Non-proliferative diabetic retinopathy (NPDR)Non-proliferative diabetic retinopathy (NPDR)
2)2) Pre-Proliferative diabetic retinopathy.Pre-Proliferative diabetic retinopathy.
3)3) Proliferative diabetic retinopathy (PDR).Proliferative diabetic retinopathy (PDR).

4. Diabetic MaculopathyDiabetic Maculopathy
1) Macular Edema1) Macular Edema
- FocalFocal
- DiffuseDiffuse
- CMECME
2) Macular Ischemia2) Macular Ischemia (Ischemic maculopathy)(Ischemic maculopathy)
3) Mixed3) Mixed

5. Non-Proliferative DiabeticNon-Proliferative Diabetic
RetinopathyRetinopathy

6. MicroaneurysmsMicroaneurysms
Retinal microaneurysms are localised focalRetinal microaneurysms are localised focal
dilatations of retinal capillaries, and appear asdilatations of retinal capillaries, and appear as
red dots. They are usually seen at the posteriorred dots. They are usually seen at the posterior
pole, especially temporal to the foveapole, especially temporal to the fovea..
Microaneurysms are the first ophthalmoscopicallyMicroaneurysms are the first ophthalmoscopically
visible change in diabetic retinopathyvisible change in diabetic retinopathy

9. Cotton Wool SpotsCotton Wool Spots
It called "soft exudates" or "nerve fibre layer microIt called "soft exudates" or "nerve fibre layer micro
infarctionsinfarctions""
They are fluffy , white lesions in the nerve fibreThey are fluffy , white lesions in the nerve fibre
layerlayer

12. Hard exudatesHard exudates
Hard exudates are Intra-retinal lipid exudates inHard exudates are Intra-retinal lipid exudates in
the form of yellow deposits of lipid and proteinthe form of yellow deposits of lipid and protein
within the sensory retinawithin the sensory retina

14. Macular edemaMacular edema
Occurs due to accumulation of fluid
and protein deposits on or under the macula of
the eye
Chronic or uncontrolled diabetes can affect
peripheral blood vessels with fluid leakage and
occasionally fats into the macula causing it to swell

15. TypesTypes

16. Cystoid Macular EdemaCystoid Macular Edema

18. Macular EdemaMacular Edema
OCTOCT

19. Focal MEFocal ME

20. Diffuse MEDiffuse ME

21. Treatment of Non-Proliferative DiabeticTreatment of Non-Proliferative Diabetic
RetinopathyRetinopathy
Follow upFollow up

22. Treatment of Macular edemaTreatment of Macular edema
OCTOCT is mandatoryis mandatory
CME :CME : Intravitreal injection of Steroids or antiIntravitreal injection of Steroids or anti
VEGFsVEGFs
Focal ME:Focal ME: Focal argon laserFocal argon laser
Diffuse ME:Diffuse ME: injection followed by macular gridinjection followed by macular grid
Vitrectomy:Vitrectomy: Vitreomacular tractionVitreomacular traction

23. Macular IschemiaMacular Ischemia
Maculopathy in diabetic retinopathy is mainly dueMaculopathy in diabetic retinopathy is mainly due
to drop out of the perifoveal capillaries with nonto drop out of the perifoveal capillaries with non
perfusion and the consequent development of anperfusion and the consequent development of an
ischaemic maculopathy

24. DiagnosisDiagnosis
Signs: are variable and the macula may look
relatively normal despite reduced visual acuity.
In other cases PPDR may be present.
FA shows capillary non-perfusion at the fovea
(an enlarged FAZ) and frequently other areas of
capillary non-perfusion at the posterior pole and
periphery.

26. Proliferative DiabeticProliferative Diabetic
RetinopathyRetinopathy

27. Neovascularization
Neovascularization is clinically characterized by
fine loops or networks of vessels lying on the
surface of the retina and extending into the
vitreous cavity
Types:
-NVDs
--NVEsNVEs

28. NVDs

30. NVEsNVEs

33. Treatment of Proliferative DiabeticTreatment of Proliferative Diabetic
RetinopathyRetinopathy
1) Treatment of Associated Risk Factors1) Treatment of Associated Risk Factors
2) Laser Photocoagulation2) Laser Photocoagulation
3) Intravitreal Anti-VEGF Treatment3) Intravitreal Anti-VEGF Treatment
4) Vitrectomy4) Vitrectomy

34. Main therapyMain therapy
Pan retinal photocoagulationPan retinal photocoagulation
(PRP(PRP((

36. Advanced Diabetic eye diseaseAdvanced Diabetic eye disease
Vitreous hemorrhageVitreous hemorrhage
Tractional retinal detachmentTractional retinal detachment

37. Vitreous HmgeVitreous Hmge

40. Tractional retinal detachmentTractional retinal detachment

41. TreatmentTreatment
pars plana vitrectomy endolaser applicationpars plana vitrectomy endolaser application

42. Thank You