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Diabetic Retinopathy  Waseem Al-Zamil, MD.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence ,[object Object],[object Object]
Prevalence ,[object Object],[object Object],[object Object]
Prevalence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence ,[object Object],[object Object],[object Object],[object Object],[object Object]
RISK FACTORS   ,[object Object],[object Object],[object Object],[object Object],[object Object]
RISK FACTORS ,[object Object],[object Object]
RISK FACTORS ,[object Object],[object Object],[object Object],[object Object]
RISK FACTORS ,[object Object],[object Object],[object Object],[object Object],[object Object]
RISK FACTORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ocular Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ocular Risk Factors ,[object Object],[object Object],[object Object]
Ocular Risk Factors ,[object Object],[object Object],[object Object],[object Object]
PATHOGENESIS  ,[object Object],[object Object],[object Object],[object Object]
 
PATHOGENESIS ,[object Object],[object Object],[object Object],[object Object]
PATHOGENESIS ,[object Object],[object Object],Microvascular occlusion retinal ischaemia   retinal hypoxia  Arteriovenous shunts ( IRMA ) Neovascularization
New vessel proliferation Fibrous glial tissue proliferaion Tractional RD  RD IRMA
PATHOGENESIS ,[object Object],[object Object],[object Object],[object Object],Leakage : Absorption : - Microanurerysms. - Incompetent  capillaries - Uptake from adjusent capillaries - Healthy RPE cells
PATHOGENESIS Loss pericytes   Microvascular leakage haemorrhage  retinal oedema   Diffuse   Localized Microanurysm ”   ”
CLINICAL FEATURES   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Optical coherence tomographic patterns of diabetic macular edema   ,[object Object],[object Object],[object Object],Kim BY, Smith SD, Kaiser PK: Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol 142(3):405-412, 2006
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object],[object Object]
Classification of severity of diabetic retinopathy   ,[object Object],4 : 2 : 1 Rule Microaneurysms, retinal hemorrhage and hard exudate  Mild NPDR Mild NPDR plus cotton wool spots . Moderate NPDR  ,[object Object],[object Object],[object Object],[object Object],Severe NPDR  Two or more of the above features described in severe NPDR  Very severe NPDR
Classification of severity of diabetic retinopathy ,[object Object],New vessels and/or fibrous proliferations; or preretinal and/or vitreous hemorrhage   Early PDR ,[object Object],[object Object],[object Object],PDR with HRC  ,[object Object],[object Object],[object Object],Advanced PDR
Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Testing ,[object Object],[object Object]
Diagnostic Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of proliferative diabetic retinopathy ,[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF DIABETIC RETINOPATHY   ,[object Object],[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF DIABETIC RETINOPATHY   ,[object Object],[object Object]
Macular oedema   ,[object Object],[object Object]
Clinically significant macular oedema  (CSMO)   ,[object Object],[object Object],[object Object],[object Object]
 
Focal laser photocoagulation   ,[object Object]
Focal laser photocoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Direct treatment   ,[object Object],[object Object],[object Object],[object Object],[object Object]
1500 mirco 500 micro 3000 micro
Direct treatment ,[object Object]
Grid treatment   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Macular oedema treatment ,[object Object],[object Object],[object Object]
Focal Laser Side Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anti-VGEF & Macular Edema
Anti-VGEF & Macular Edema
Algorithm for panretinal scatter coagulation of the retina
laser photocoagulation ,[object Object],[object Object],[object Object],[object Object]
laser photocoagulation   ,[object Object],[object Object],[object Object],[object Object]
laser photocoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object]
laser photocoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
laser photocoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PARS PLANA VITRECTOMY INDICATIONS   ,[object Object],[object Object],[object Object],[object Object],[object Object]
PARS PLANA VITRECTOMY INDICATIONS ,[object Object],[object Object],[object Object],[object Object]
Follow up Suggested follow-up Retinal Finding Annually Normal Every 9 months Mild NPDR Every 6 months Moderate NPDR Every 4 months Sever NPDR Every 2- 4 months CSME Every 6 months CNSME Every 2-3 months PDR
Aspirin & DRP ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sorbinil & DRP ,[object Object],[object Object]
Practical Points ,[object Object],[object Object],[object Object],[object Object]
Practical Points ,[object Object],[object Object],[object Object],[object Object]
Practical Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Practical Points ,[object Object],[object Object],[object Object],[object Object]
Practical Points ,[object Object],[object Object],[object Object],[object Object],[object Object]
Remember ,[object Object],[object Object],[object Object],[object Object]

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New diabetic retinopathy

Editor's Notes

  1. Figure 87-16 Diabetic macular edema. Color fundus photograph (left) of a 63-year-old man with diabetic macular edema and nonproliferative diabetic retinopathy. Retinal edema is appreciated along with numerous exudates adjacent to the foveal center. Horizontal optical coherence tomography scan (right) through the fovea shows diffuse intraretinal cystic thickening with loss of the normal foveal depression. Intraretinal hyperreflective foci with posterior optical shadowing correspond to areas of retinal exudates seen clinically. A focal area of shallow subretinal fluid is noted centrally .