Prepared By Muhd Ariff Mahdzub Opthalmology Posting 4th year Mbbs Widad University College

1. B Muhd Ariff Mahdzub
DIABETIC
RETINOPATHY

2. DIABETIC RETINOPATHY
Retinal changes as a
complication of or due to
diabetes mellitus (DM)

3. • In Malaysia, diabetic eye disease is the commonest cause of
visual loss among adults of working age
• Prevalence is closely-related to duration of diabetes
• At diagnosis of DM, prevalence is only less than 5% but
after 10 years, it rises up to 40% – 50%
• The risk factor includes duration of having diabetes, poor
glucose control, hypertension, obesity, and pregnancy.
• Annual screening is recommended for diabetic patient for
early detection enabling well-planned treatment.

4. PATHOPHYSIOLOGY

5. Retinal ischemia
Reduced blood flow, decreases of
vascular endothelial retinal perfusion
Release vascular
endothelial growth factor
New blood vessels grow and proliferate inside the retina and
vitreous humor
However, these new blood vessels can easily rupture and bleed,
cloud vision and damage retina
Fibrovascular proliferation occurs as part of healing
process due to rupture vessels
Neovascular glaucoma occur if the new blood
vessels grow in the anterior chamber
Tractional retinal detachment

6. Figure (i) Looping Figure (ii) Beading Figure (iii) Severe
segmentation
Venous changes

7. Cotton wool
Neovascularization
Arises from the optic nerve head along the large vessels

9. CLASSIFICATION

10. SCREENING

11. FOLLOW UP
• Diabetic persons should be screened at least
every 2 years
• High risk individuals should be examined
annually which are
– Individuals with longer diabetes duration
– Individuals with poor glucose control
– Individuals with poor blood pressure
control
– Individuals with poor serum lipid control
• The examination should include
– Visual acuity assessment (Snellen chart and
equivalent)
– Fundus photography or dilated fundus
examination
• Individuals with any signs of NPDR should be
examined at 6-12 months interval
• Earlier follow-up may be required in those of /
with
– High risk groups
– Presence of renal complications
– Progression of DR

12. REFERRAL CRITERIA
• Individuals with any of the
criteria below should be
referred to ophthalmologist
– Any level of diabetic
maculopathy
– Severe NPDR
– Any PDR
– Unexplained visual loss
– If screening examination
cannot be done, including
ungradable fundus photo

13. TREATMENT
• DR is reversible
with early
detection
• Laser
photocoagulati
on is the
standard
practice for
treating DR
• However, there
are different
types of
treatment of
DR based on its
stages as

14. TREATMENT (cont.)
• Laser photocoagulation
– Widely used for early stages of proliferative retinopathy
• Sealing of leaking blood vessels
• Treat macular edema
• Halt neovascularization
• Vitrectomy
– Removal and replacement of cloudy vitreous due to blood
accumulation with normal saline
– Done in patients with proliferative diabetic retinopathy
– Able to restore vision, specially effective for insulin-dependent
diabetic patient
• Anti-VEGF therapy
– Multiple injections of anti-VEGF drugs used in combination with
laser photocoagulation for diabetic macular edema