Dear Friends, This presentation is basically targeted for MD Residents and Ophthalmologists who are tired of going through many presentation to get full practical information regarding Diabetic Retinopathy.You will get mainly full practicle information( rather than long tiring theoretical presentations) needed for your clinical practice.Pls dont forget to give feedback

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A to Z of Diabetic Retinopathy
Gyanendra Lamichhane, MD
Associate Professor of Ophthalmology,NAMS
Lumbini Eye Institute
Bhairahawa, Nepal

2. • Introduction
• Epidemiology and prevalence
• Risk factors
• Pathogenesis
• Clinical Feature
• Management
• Screening & follow up schedule
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6. Various Studies
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7. 1.Duration of DM
Most important risk factor
DM dx before age of 30 yrs
after 10 yrs….50% develops Retinopathy
after 30 yrs….90% develops Retinopathy
After 20 yrs of DM
99% of type 1 and 60% of type 2 DM develops
retinopathy
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9. 2.Poor Glycemic Control
• Severity of hyperglycemia is the key alterable risk factor
• Tight Blood sugar control delay both
development and progression of DR
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Target Hb A1C = 6.5-7%

12. 3.Pregnancy
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15. 6.Cataract Surgery
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24. Classification
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25. • Non Proliferative Diabetic Retinopathy( NPDR)
Mild
Moderate
Severe
Very Severe
• Proliferative Diabetic Retinopathy ( PDR)
High Risk Charecter
• Clinically Significant Macular Edema
• Advanced Diabetic Eye Disease
Vitreous Haemorrhage
Tractional Retinal Detachment
Neo Vascular Glaucoma 25

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27. Common Terminologies
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38. Soft Exudates ( Cotton wool Spot)
Chronic Hypoglycemia
Nerve fiber layer ischemia
axoplasmic stasis
gross axoplasmic distension
CWS
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41. Venous and Arterial Changes
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44. New Vessel VS IRMA
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47. PDR
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48. Macular Edema in Diabetes
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49. Pathophysiology
Basic concept is ( always keep in mind)
• DME is caused by Combined mechanism
a) VEGF medicated…….so role of Anti VEGF
b) Inflammatory mediator…..role of intra vitral steroid
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51. Diabetic Macular edema
• leading cause of blindness in young adults in developed
countries
• Prevalence varies
• Diabetes Control and Complications Trial (DCCT)
DM1 …..27% developed macular edema within 9 years of
onset
• DM2……prevalence increases from 3% within 5 years of
diagnosis to 28% after 20 years
• The annual incidence of DME in DM1 ranges from 0.9% to
2.3%
The Wisconsin Epidemiologic Study of Diabetic Retinopathy

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70. • Clinical features
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82. • We mainly need to treats
severe NPDR ( selected cases)
PDR ( better to treat all cases)
CSME
Complications
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83. Photocoagulation
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88. Laser Spot Size Adjustment Required for Different
Lenses Contact
Lens Field of Vision Spot
magnification
Spot Size Setting
for ~500 um
Mainster Wide-
Field
125° 1.50x 300µm
Volk
TransEquator
120-125° 1.43x 300µm
Volk
Quad/Aspheric
130-135° 1.92x 200 to 300µm
Mainster PRP 165 160° 1.96x 200 to 300 µm
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89. • A total of 1600-3000 burns are placed in 1 or more
sittings (2-4 week apart)
• Mild and moderate PDR: 1 burn width apart
• Severe PDR: 0.5 to 0.75 burn width apart
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93. Evidence based Practice in
DME

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98. Intra vitreal Steroid in DME
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102. DME Recommendation
Once DME confirmed Clinically
OCT--- in all cases for baseline CFT and volume
FFA--- in selected cases like ..
severe NPDR,
suspected NVE,
macular ischemia and
plan for focal laser
Always start with anti VEGF if intravitral therapy is needed
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103. Focal and Grid Laser
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104. Focal laser area
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107. • Surgical Treatment
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117. • Thank you
for feedback
yourgyanu@gmail.com
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