diabetic%20retinopathy
DIABETIC RETINOPATHY
Treatment Guideline Chart
Diabetic retinopathy is an abnormality of the microvasculature of the retina that occurs to almost all patients with chronic diabetes mellitus.
It is one of the leading cause of blindness worldwide and principal cause of impaired vision in patients aged 25-75 years of age.
The abnormality causes microaneurysms, retinal hemorrhages, lipid exudates, macular edema & neovascular vessel growth that may lead to blindness.

Diabetic%20retinopathy Signs and Symptoms

Introduction

  • A progressive retinal disorder that occurs in almost all patients with chronic diabetes mellitus (DM)
  • One of the leading cause of preventable vision impairment and blindness worldwide
  • Principal cause of impaired vision in patients aged 25-74 years
  • Leading complication of DM
  • Earliest visible manifestations are microaneurysms and hemorrhages

Pathophysiology

  • Believed to be a result of different biochemical changes (eg aldose reductase, protein glycation, protein kinase C activation, angiotensin enzyme expression, vascular endothelial growth factor expression, etc) accompanied by blood retinal barrier increased permeability and initially by increases in retinal blood flow
    • Resulting widened venular caliber is a marker of the severity of diabetic retinopathy (DR)

Signs and Symptoms

Clinical Presentation

  • Initial clinical signs of diabetic retinopathy are:
    • Thickening of the retinal basement membrane
    • Microaneurysms or hypercellular outpouchings of retinal capillaries with weakened walls due to pericyte loss
    • Leakage of lipid and proteinaceous material (hard exudates)
  • Signs that would lead to visual impairment:
    • Presence of macular edema
    • Presence of new vessels at the optic disc (NVD) or new vessels elsewhere in the retina (NVE)
    • Manifestations of severe NPDR that includes: Extensive retinal hemorrhages/microaneurysms, venous beading and intraretinal microvascular abnormalities (IRMA)
    • Vitreous or preretinal hemorrhage
  • The basic changes in the retinal vessels are:
    • Abnormal permeability and vascular occlusion with ischemia
    • Subsequent neovascularization
  • Typical retinal microvascular lesions of DR are:
    • Microaneurysms
    • Hard exudates
    • IRMA
    • New vessels or neovascularization
    • Hemorrhages
    • Cotton wool spots
    • Venous beading
    • Fibrous tissue

Risk Factors

  • Visual loss from diabetic retinopathy is caused either by:
    • Macular edema
    • Vitreous hemorrhage
    • Neovascular glaucoma
    • Macular capillary nonperfusion
    • Distortion or traction detachment of the retina
  • The major risk factors in the development of diabetic retinopathy are the duration of diabetes and the severity of hyperglycemia
    • Other risk factors include pregnancy, puberty, cataract surgery, medical conditions (eg hypertension, hyperlipidemia)
    • Associated with poor control of blood glucose, blood lipids and blood pressure
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