2. introduction
Diabetes mellitus describes a metabolic
disorder characterized by chronic
hyperglycemia resulting from defects in
insulin secretion , insulin action, or both.
It is the leading cause of preventable
blindness in individual 40 to 60 years of
age.
The rate of blindness among diabetic
persons is 20 times that of the general
population.
3. Diabetic Retinopathy
This is the disease of the retina caused by
microangiopathy due to long term effect of
diabetes leading to the damage of the retina
and blindness
It is the most important ocular complication of
diabetes.
Prevalence of DR of any severity in the diabetic
population is 30%.
Prevalence of blindness due to DR is
approximately 5%.
4. RISK FACTORS
Duration of DM
poor control of diabetes
Hypertension
Renal Disease
Pregnancy
Nephropathy
others; Obesity, hyperlipidaemia,
smoking, anaemia
5. PATHOPHYSIOLOGY
This is a Microangiopathy diseases
primarily affecting the precapillary
arterioles and capillaries , venules
and post capillary venules.
The basic component of damaging is
microvascular occlusion and
microvascular leakages
8. PATHOGENESIS
DR is predominantly a microangiopathy in which small
blood vessels are particularly vulnerable to damage
from high glucose levels.
Direct hyperglycemic effects on retinal cells are also
likely to play a role.
Many angiogenic stimulators and inhibitors have been
identified; vascular endothelial growth factor (VEGF)
appears to be of particular importance.
9. Diabetic retinopathy
symptoms
DR is asymptomatic in early stages but as the
disease progresses symptoms may include:
Blurred vision
Floaters
Distorted vision
Dark areas in the vision
Poor night vision
Impaired colour vision
Partial or total loss of vision
10. Diabetic retinopathy signs
Microaneurysms; these are localized
outpouchings, mainly saccular, of the capillary
wall that may form either by focal dilatation of
the capillary wall where pericytes are absent,
or by fusion of two arms of a capillary loop.
Retinal hemorrhage
Exudate
17. Cont.
Severe:
The (4-2-1) rule; any one of the following
4 quadrants of microaneurysms and extensive
intraretinal haemorrhage
2 quadrants of venous beading
1 quadrant of IRMA
18. Cont….
Very severe
The (4-2-1) rule; any two of the following
4 quadrants of microaneurysms and extensive
intraretinal haemorrhage
2 quadrants of venous beading
1 quadrant of IRMA
19. Proliferative diabetic
retinopathy
Mild-moderate PDR
New vessels on the disc (NVD) or new vessels
elsewhere(NVE), but extent insufficient to meet the
high-risk criteria
Treatment considered according to severity of signs,
stability, systemic factors, and patient’s personal
circumstances such as reliability of attendance for
review
If not treated, review in up to 2 months
20. NVD > 1/3 disc in area Less extensive NVD
+ haemorrhage
MILD MODERATE
21. High-risk PDR
• New vessels on the disc (NVD) greater than ETDRS
• Any NVD with vitreous haemorrhage
• NVE greater than 1/2 disc area with vitreous haemorrhage
• Treatment Should be performed immediately when possible,
and
• certainly same day if symptomatic presentation with
• good retinal view
24. DIABETIC MACULOEDEMA
Diabetic macular edema is the leading cause of legal
blindness in diabetics
Diabetic macular edema can be present at any stage of
the disease, but is more common in patients with
proliferative diabetic retinopathy
25.
26. International Clinical Diabetic
Macular Edema
Disease Severity Scale
DME apparently absent -No apparent retinal thickening
or hard exudates in posterior pole
DME apparently present -Some apparent retinal
thickening or hard exudates in posterior pole
DME present ;
Mild DME- Some retinal thickening or hard exudates in
posterior pole but distant from the center of the macula
Moderate DME- Retinal thickening or hard exudates
approaching the center of the macula but not involving
the center
Severe DME- Retinal thickening or hard exudates
involving the center of the macula
36. Treatment of diabetic
retinopathy and diabetic
maculo oedema
1.Laser photocoagulation treatment
Focal-diode or argon burns are
applied to leaking microaneurysms
500-3000um from the foveola
Grid-burns are applied to macula
areas of diffuse retinal
thickening,treating no closer than
500um from the foveola and 500um
from the disk
2.Subthreshold micropulse diode laser
Uses very short laser pulse duration
combined with a loner interval
37. CT.
5.Pars plana vitrectomy-
Indicated when macula oedema is
associated with tangential traction from a
thickened and taut posterior
hyaloid(vitreomacular traction)
Intraocular injection treatment
Steroid intravitrial implant treatment
