This document provides an overview of diabetic retinopathy. It defines diabetic retinopathy as a non-inflammatory disease of the retina caused by chronic hyperglycemia. It then covers the epidemiology, risk factors, pathogenesis, classification, signs and symptoms, and treatment options for diabetic retinopathy. The classification system divides diabetic retinopathy into non-proliferative and proliferative stages. Treatment involves medical approaches like anti-VEGF drugs and steroids, laser photocoagulation surgery, and vitrectomy.

1. Presented by :
DR AWAIS IRSHAD

2. Learning objectives
• Define Diabatic retinopathy
• Epidemiology of Diabatic retinopathy
• Causes and identity the Risk factors of Diabatic
RETINOPATHY
• Pathogenesis of Diabatic Retinopathy
• Classification of Diabatic Retinopathy
• Describe and distinguish between the stages of
Diabatic RETINOPATHY
• Signs and Symptoms
• Treatment options

3. IT IS A NON INFLAMMATORY DISEASE OF THE RETINA,
CHARACTERIZE BYPROGRESSIVE DYSFUNCTION OF THE
RETINAL VASCULATURE SECONDARY TO CHRONIC
HYPERGLYCEMIA.
MOSTY OCCUR IN PATIENT BETWEEN 25 AND 75 YEARS
OF AGE

4. Epidemiology
Risk Factors developing DR:
Type I or IDDM 70%
Type II or NIDDM 39%
Type II or IDDM 70%

5. Risk Factors
Non
Modifiable:
Puberty
pregnancy
Modifiable:
Obesity
Hyperglycemia
Dyslipidima
Hypertension
Others:
Genetic factors :
HLA3,HLA4
Apolipoproteins,ApoB

6. TYPE II IN 90%OF THE PATIENTS
DIABATIC RETINOPATHY MOST
COMMON CAUSE OF LEGAL BLINDNESS
BETWEEN AGE OF 20 AND 70 YEARS

7. Pathogenesis
• The exact lesion in diabatic retinopathy is
MICROANGIOPATHY affecting:
• precapilary venules
• capillaries
• venules
Microangiopathy has feature of:
• Microvascular leakage
• Microvascular occlusion

8. Microvascular (capillary) leakage:
Loss of pericytes that wrap around the endothelial cells of
the capillaries , essential for structural integrity , results:
• Microaneurism
• breakdown of blood retinal
barrier
As a result of leakage
• Retinal oedema
• Exudates
• retinal
haemorrhages

10. Microvascular capillary occlusion
caused by:
• Thickening of the capillary basement membrane
• Endothelial cell damage and proliferation
• Increase stickiness and aggregation of platelets
• reulex formation by RBCs
• Defective oxygen transport due to RBCs change
• Fibrinolytic system become defective

13. Result of microvascular occlusion:
• Cotton wool spots
• Intraretinal microvascular
occlusion
• neuvascularization (VEGF)

14. • Gradual vision loss due to involvement of macula
• Sudden vision loss due to vitrious haemorrhages

15. Classification of Diabatic
retinopathy
• Non proliferative
DR:
• Mild
• Moderate
• Severe
• very
severe
• Proliferative
DR
• Clinically significant Macular oedema
• Advance Diabatic eye

16. Mild NPDR
• At least one Microaneurism
• Retinal
haemorrhages
• Hard or soft exudates

17. Moderate
NPDR
• Microaneurism
• Retinal haemorrhages
• Exudates
• Venous beading

18. At least one of the
following:
The rule 4-2-1 Any one of this rule:
• Severe haemorrhages in all 4 quadrants
• Significant venous beading in 2 or more or
more quadrants
• Moderate IRMA (intraretinal microvascular
Abnormalities) in one or more quadrants
Severe
NPDR

19. • Very severe
NPDR
• Any 2 of the features of the 4-2-1
rule is present

21. Proliferative
DR
• New vessels form on
disc
• New vessels elsewhere

22. Diabatic macular
oedema
• It occurs at any stage from mild NPDR to
PDR
• focal oedema or with exudates
• Diffuse oedema, haemorrhages and
exudates

23. Advance Diabatic eye disease
(ADED)
• Persistent vitrious haemorrhages
• Tractional retinal detachment due to traction by
viteroretinal fibrosis
• Neovascular glaucoma due to iris neovasculrization

24. Complications to
DR
• Vitrious haemorrhages
• Tractional retinal detachment
• Rubeosis Iridis
• Blindness

26. Tractional retinal

27. Rubeosis Iridis

28. Management
• History from the patient
• clinical features
• Ocular examination
Fundus examination with:
• Direct ophthalmoscope
• Indirect ophthalmoscope
• Slit lamp biomicroscopy with contact lens
and non contact lens
Fundus florescent Angiography (for vascular function)
• Optical coherence Tomography(OCT)

29. Investigations
• Blood sugar level
• Urine Analysis
• lipid profile
• Glycosylated HbA1 c

30. Treatmen
t
• Medical
• laser
• Surgical (Pars plana Victromy)
Medical
• Anti VEGF
• Bevacizuma
b
• Ranicizumab
• Intravitreal steroids for
edema(triamicinolone
acetonide)

31. Laser
Photocoagulation
• To destroy the hypoxic retina
• To close the leakage areas

32. Surger
y
• Pars plana Victromy in diabatic Retinopathy often
combined with endolaser panretinal
Photocoagulation