Diabetic retinopathy

1. Optom. Sameep Adhikari

2.  Series of retinal changes that occur in patients with
DM
 Serious sight-threatening complication of DM
 Most common cause for legal blindness
 Common in type I DM than type II
11/1/2015DR 2

3.  Duration of DM:
 Mostly >10 yrs
 Poor metabolic control
 Pregnancy
 Hypertension
 Nephropathy
 Heredity
 Smoking
 Obesity
11/1/2015DR 3

4. Microangiopathy
Microvascular
occlusion
Retinal
ischaemia
Arteriovenous
shunt
formation
Neovascularisation
Capillary
leakage and
haemorrhage
Microaneurysm
Retinal oedema Hard exudates
11/1/2015DR 4

5.  Early stage:
 Asymptomatic
 Advance stage:
 Seeing spots or floaters in visual field
 Blurred vision
 Distorted vision
 Difficult in seeing well at night
11/1/2015DR 5

6.  Background Diabetic Retinopathy:
 Microaneurysms:
 Tiny, round, red dots located in INL
 FFA shows tiny hyperfluorescent dots representing non-
thrombosed microaneurysms
 Hard exudates:
 Waxy-yellowish lesions with distinct margins at OPL
 FFA shows hyperfluorescence due to blockage of background
choroidal fluorescence
11/1/2015DR 6

7.  Retinal oedema:
 Initially, located between OPL and INL
 Best detected by fundus examination with Goldman lens
 FFA shows diffuse late hyperfluorescence due to retinal
capillary leakage
 Haemorrhage:
 Intra retinal haemorrhage from venous end of capillaries
 Dot and blot haemorrhage
 Retinal nerve fibre layer haemorrhage due to larger pre-
capillary arterioles
 Flame shaped haemorrhage
11/1/2015DR 7

8.  Management:
 No treatment required
 Review annually
 Associated factors should be controlled
11/1/2015DR 8

9.  Is BDR that shows the signs of proliferative DR
 Signs:
 Cotton wool spots:
 Local infarcts of RNFL due to blockage of pre-capillary
arterioles
 Small whitish superficial lesions
 FFA shows hyperfluorescence
11/1/2015DR 9

10.  Intraretinal microvascular abnormalities(IRMA):
 Shunts that runs from arterioles to venules by-passing
capillary bed
 FFA shows focal hyperfluorescence at areas of capillary
closure
 Venous changes:
 Dilatation of veins
 Venous looping
 Arterial changes:
 Narrowing
 Silver-wiring
11/1/2015DR 10

11.  Dark blot haemorrhage:
 Haemorrhagic retinal infarcts located within middle
layers of retina
 Management:
 Reviewed in regular basis
 Photocoagulation can be done if follow up is not
possible
11/1/2015DR 11

12.  Involvement of fovea by oedema, hard exudates or
ischaemia
 Classification:
 Focal exudative
 Well-circumscribed retinal thickening along with hard
exudates
 FFA shows focal hyperfluorescence due to leakage and
macular perfusion
 Diffuse exudative
 Diffuse retinal thickening associated with cystoid changes
 FFA shows widespread spotty hyperfluorescence of
microaneurysms and late diffuse hyperfluorescence which
shows flower petal pattern , if CMO is present
11/1/2015DR 12

13.  Ischaemic:
 Associated with pre-proliferative DR
 FFA shows capillary non-perfusion at fovea
 Mixed:
 Characterized by both ischaemia and exudation
11/1/2015DR 13

14.  Clinically significant macular oedema(CSME):
Diabetic maculopathy can lead to CSME if present
with,
 Retinal oedema within 500µm centre of fovea
 Hard exudates within 500µm centre of fovea and
associated with adjacent retinal thinking
 Retinal oedema, one disc diameter or larger in size, at
least a part of which is within one disc diameter of foveal
centre
 Management:
 Argon laser photocoagulation
 Vitrectomy
11/1/2015DR 14

15.  DR in long run can lead to Proliferative DR
 Signs:
 Neovascularisation is hallmark of proliferative DR
 Neovascularisation may be;
 NVD- New vessels at disc
 NVE- New vessels elsewhere
 FFA detects neovascularisation in early stage and shows
late hyperfluorescence due to leakage from new vessels
 Management:
 Panretinal photocoagulation
11/1/2015DR 15

16. 11/1/2015DR 16

17.  Serious sight threatening complication of DR
 Some complications are:
 Pre-retinal haemorrhage
 Tractional retinal detachment
 Rubeosis iridis
 Management:
 Pars-plana vitrectomy
11/1/2015DR 17

18.  What is his major complaints
 Whether he has blurred vision or not
 Whether he has distorted vision or not
 Whether he is seeing floaters or not
 Whether he can appreciate black spots while seeing
 Whether he is suffering from DM or not
 If yes, since when
 Whether he is suffering from hypertension or any other
systemic disease
 Whether his family members had DR or any similar
symptoms
 His blood sugar report!!
11/1/2015DR 18

19. 11/1/2015DR 19