Diabetic retinopathy is progressive dysfunction of retinal blood vessels due to hyperglycemia. It is the leading cause of blindness among working-age adults. The risk increases with duration of diabetes and is also increased by hypertension, smoking, and renal disease. Early stages are asymptomatic but can progress to proliferative diabetic retinopathy with neovascularization, potentially leading to vitreous hemorrhage or retinal detachment. Treatment depends on severity and may include laser photocoagulation, intravitreal injections, or vitrectomy surgery. Regular screening is important to detect diabetic retinopathy early and prevent vision loss.

1. Diabetic Retinopathy
AZIZUDDIN
MBBS-III
JMDC

2. DIABETIC RETINOPATHY
• DEFINED AS PROGRESSIVE DYSFUNCTION
OF RETINAL BLOOD VESSELS DUE TO
HYPERGYLCEMIA.

3. Retinal Topography

4. Retina: Schematic Diagram

5. Diabetic Retinopathy
• The best predictor of diabetic retinopathy is the
duration of the disease.
• Type I diabetes The first 5 years of type 1 diabetes has a
very low risk of retinopathy. All patients develop
retinopathy in 15 years.
• Type II diabetes: Risk of retinopathy increases with
duration of diabetes , hypertension and smoking, and
renal pathology.

6. Diabetic Retinopathy
Risk factors:
• Diabetic age and age of the patient
• Glycemic control
• Hypertension
• Poor renal status
• Smoking
• Pregnancy, obesity, hyperlipidemia, anemia

14. Consequences of chronic leakage

17. Clinical Features
• Asymptomatic in the beginning
• Symptoms depend upon the retinal changes.
• Painless diminution of vision
• Dilated fundus examination shows typical
features.

18. Fundus Findings
Features of NPDR
● Microaneurysms
● Dot and blot hemorrhage
● Retinal edema and exudates
● Dilatation and beading of
retinal veins
● Intra retinal Microvascular
Abnormalities (IRMA)
Features of PDR
Neovascularization disc (NVD)
Neovascularization elsewhere(NVE)
In addition to other changes of NPDR

19. Early NPDR

20. Macular Edema

21. Proliferative Diabetic Retinopathy
Extra retinal fibrovascular proliferation
extends beyond the internal limiting
membrane (ILM).
• It’s the commonest cause of spontaneous
vitreous hemorrhage in adults.
• About 2/3rd of Type I diabetics are likely to
develop PDR over 3 decades.

22. Proliferative Diabetic Retinopathy

24. Causes of Visual Impairment
NPDR
● Macular edema (capillary
leakage)
● Macular ischemia (capillary
occlusion)
● Sequelae from ischemia
related neovascularization
PDR
• Vitreous hemorrhage, retinal
detachment.
• Diabetic macular edema
• Ischemic macular changes

25. Diagnosis of Diabetic Retinopathy
Clinical Exam
• Direct ophthalmoscopy under mydriasis
• Slit lamp biomicroscopy using +90 D lens
• Fluorescein angiography

26. Screening Schedule
• : Normal fundus , rare microaneurysms:
Annual review
• Mild NPDR: Every 9 months
• Moderate NPDR: Every 6 months
• Severe NPDR, CSME: Every 2-4 months
• PDR: Every 2-4 months

27. Treatment of
Diabetic Macular Edema (DME)
Laser Photocoagulation
• Grid laser :For diffuse retinal thickening outside FAZ.
• Focal laser : microaneurysms in centre of hard exudates.
Medical Treatment:
-intravitreal injection: Triamcinolome acetonide / anti-
VEGF
- posterior sub-tenon injection of corticosteroid
Surgery: Parsplana vitrectomy

28. Treatment of PDR
• Panretinal Laser photocoagulation (PRP) : For
NVD And NVE
• Vitreoretinal surgery and PRP :
- Severe persistent vitreous hemorrhage
- Dense, persistent premacular hemorrhage
- Progressive proliferation despite laser therapy
- Retinal detachment involving macula

29. • Spot size (200-500 m)
• Follow-up 4 to 8 weeks
• Area covered by complete PRP
• Initial treatment is 1200
+ burns
Laser Panretinal Photocoagulation(PRP)

30. Prevention Visual Loss
• Patient education and good diabetic control
• Control of hypertension, hyperlipidemia, renal
disease, anaemia, and avoidance of smoking
• Periodic dilated fundus examination
• Early treatment of macular edema and PDR
• Treatment of complications