This document discusses diabetic retinopathy, which is a microvascular complication of longstanding diabetes mellitus that causes damage to the blood vessels in the retina. It is the most severe ocular complication of diabetes and the most common cause of blindness between ages 20-65. The risk and progression of diabetic retinopathy increases with longer duration of diabetes, poor blood sugar control, pregnancy, hypertension, nephropathy, and other factors. The document describes the pathogenesis, classification, signs, and treatment options for diabetic retinopathy.

1. Diabetic Retinopathy
Presented By
Dr. Md. Rezwanul Hasan
Jr. Consultant, Vitreo-Retina Dept.,
Deep Eye Care Foundation & Eye Hospital

2. Diabetic retinopathy
 The most severe of ocular complications of diabetes
 Caused by damage to blood vessels of the retina,
leads to retinal damage
 Microvascular complication of longstanding diabetes
mellitus
 Most prevalence cause of legal blindness between
the ages of 20 and 65 years
 Common in DM type 1 > type 2

4.  Duration of diabetes
 Most important factor
 Patient diagnosed before age 30 year
50% DR after 10 yrs
90% DR after 30 yrs
 Poor metabolic control
 Relevant to development and progression of DR
  HbA1c associated with  risk
 Pregnancy
 Associated with rapid progression of DR
Risk factors

5.  Hypertension
 Very common in patients with DM type 2
 Should strictly control (<140/80 mmHg)
 Nephropathy
 Associated with worsening of DR
 Others
 Obesity, increased BMI, high waist-to-hip ratio
 Hyperlipidemia
 Anemia
Risk factors

6.  Microvascular occlusion
 Microvascular leakage
Pathogenesis

7. Microvascular leakage
Degeneration and loss of pericytes
Plasma leakage
Intraretinal hemorrhage
Hard exudate
(Circinate pattern)
Capillary wall weakening
microaneurysm
Retinal edema

8. Microvascular occlusion
Neovascularization
and fibrovascular proliferation
VEGF
Increased plasma viscosity
Deformation of RBC
Increased platelets stickiness
Decreased capillary blood flow
and perfusion
Endothelial cell damage and proliferation
Capillary basement membrane thickening
Retinal hypoxia
A-V shunt
IRMA*
*intraretinal microvascular abnormalities
Proliferative
retinopathy
Rubeosis iridis

9. Classification
 Non-proliferative diabetic retinopathy (NPDR)
 Mild NPDR
 Moderate NPDR
 Severe NPDR
 Proliferative diabetic retinopathy (PDR)

10.  Microaneurysm
 Retinal hemorrhage
“Dot or Blot” Spot
“Flame or Splinter shape” hemorrhage
 Hard exudate
 Cotton wool Spot
 Venous beading
 Intra-retinal microvascular abnormalities (IRMA)
Signs of NPDR

11.  The earliest signs of DR
 Localized saccular outpouchings of capillary
wall  red dots
 Focal dilatation of capillary wall where
pericytes are absent
 Fusion of 2 arms of capillary loop
Microaneurysm

12. Microaneurysm

13.  Capillary or microaneurysm is weakened 
rupture  intraretinal hemorrhages
 Dot & blot hemorrhages
 Usually round or oval
 Flame-shape or splinter hemorrhages
 More superficial - in nerve fiber layer
 Absorbed slowly after several weeks
Retinal Hemorrhage

14. Dot Spot VS Flame Shape

15. Dot Spot VS Flame Shape

16. Hemorrhage

17.  Yellow deposits of lipid and protein within the
retina
 Accumulations of lipids leak from
surrounding capillaries and microaneurysms
 Hyperlipidemia may correlate with the
development of hard exudates
Hard exudate

21. Non-proliferative diabetic retinopathy
Right eye: Microaneurysm, few flame-shaped and dot-blot hemorrhages and hard
exudate [with hard exudate in macula area] - moderate non proliferative diabetic
retinopathy
Left eye: Microaneurysm, numerous flame-shaped and dot-blot hemorrhage [more than
20 dots in 4 quadrant], hard exudate [with hard exudate in macula area] - severe non
proliferative diabetic retinopathy

22.  5% of DM pt.
 Findings
 Neovascularization : NVD (Neovascularization of
disc), NVE (Neovascularization of Elsewhere)
 Vitreous changes
 Advanced diabetic eye disease
 Final stage of Uncontrolled PRD
 Glaucoma (neovascularization)
 Blindness from persistent vitreous hemorrhage
Proliferative diabetic retinopathy

24. Neovascularization of disc

25. NVE
Venous
beading
IRMA

26. New vessels of the disc (advanced)

27. Retinal detachment
Vitreous hemorrhage

29.  Prevention
 Treat underlying conditions
 Control blood sugar – HbA1c < 7
 Control blood pressure – SBP < 130 mmHg
 Control lipid profile – TG, LDL
 Correct anemia
 Control diabetic nephropathy
 Pregnancy makes DR worsen
Medical therapy

30. Laser Photocoagulation
Vitreoretinal surgery
Intravitreal triamcinolone acetonide
Anti-VEGF
Treatment

31. Thank You