Diabetic Retinopathy (DR) for undergraduate MBBS Students. Covers the basics of Aetiology, pathophysiology, clinical features, Classification and management of DR. Also encompasses salient points for PGMEE

1. Diabetic Retinopathy
Dr. Abhishek Onkar

2. • Diabetic retinopathy is a disorder of the retinal vessels that eventually
develops to some degree in nearly all patients with long- standing
diabetes mellitus.
• Contributes 4.8% of the 37 million cases of blindness throughout the
world
• A recent study in urban population in south India estimates
prevalence of DM in adult population as high as 28% & the
prevalence of DR in diabetics to 18%

10. Pathogenesis

12. NORMAL CAPILLARIES PERICYTE LOSS
MICRO ANEURYSMS
INTRARETINAL HEMORRHAGES- FLAME SHAPED/SPLINTER AND DOT-BLOT H’GE
EDEMA : CYSTOID
EXUDATES (HARD)
 ISCHEMIA
• COTTON WOOL SPOTS (“SOFT EXUDATES”)
• INTRA RETINAL MICROVASCULAR ABNORMALITIES
• Venous Loop Venous Beading Venous Segmentation Retinal arteriole obliteration
PROLIFERATIVE DR NEOVASCULARIZATION : DISC
PROLIFERATIVE DR NEOVASCULARIZATION : ELSEWHERE

18. • BACKGROUND DR (BDR)
• NON-PROLIFERATIVE DR (NPDR)
• PROLIFERATIVE DR (PDR)
• DIABETIC MACULOPATHY
• DIABETIC PAPILLOPATHY

27. Clinically Significant Macular Edema ( CSME)

28. Diabetic Papillopathy

34. Management
• History
• Duration of diabetes
• Past glycemic control (hemoglobin A1c)
• Medications
• Systemic history (e.g., obesity, renal disease, systemic hypertension,
serum lipid levels, pregnancy)
• Ocular history

35. Examination
• Visual acuity
• Measurement of IOP
• Gonioscopy when indicated (for neovascularization of the iris or
increased IOP)
• Slit-lamp biomicroscopy
• Dilated funduscopy including stereoscopic examination of the
posterior pole
• Examination of the peripheral retina and vitreous, best performed
with indirect ophthalmoscopy or with slit-lamp biomicroscopy,
combined with a contact lens

36. Ophthalmic Investigations
• Fundus Photography
• Fluorescein Angiography to:
 guide treatment of CSME
to identify Ischemic maculopathy
IRMA vs NV evaluation
• Optical Coherence Tomography:
o Retinal thickening assessment
oMonitoring of edema
o vitreo macular traction
• USG – B scan

37. ETDRS- Log MAR Visual acuity chart

40. Screening of all cases above the age of 40 years irrespective of status of diabetes

47. INTRAVITREAL BEVACIZUMAB INJECTION