diabetic%20retinopathy
DIABETIC RETINOPATHY
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.

Surgical Intervention

Laser Photocoagulation

  • Standard technique for treating DR that aims to reduce the risk of visual loss
  • Retrobulbar or peribulbar injections can be used w/ laser photocoagulation techniques

Focal laser photocoagulation

  • Applies small sized burns to leaking microaneurysms in the macula in order to reduce the plasma leakage responsible for intraretinal swelling
  • Painless & only takes <10 mins to perform under topical anesthesia
  • Indicated for patients w/ DR w/ CSME; preferably done prior to panretinal photocoagulation in patients w/ DME, w/ severe NPDR & non-high risk PDR
  • Complications can include:
    • Laser scars that tend to increase w/ time
    • Paracentral scotomas
    • Accidental foveal photocoagulation
    • Choroidal neovascularization
    • Subfoveal fibrosis

Panretinal/scatter laser photocoagulation

  • Applies hundreds of laser wavelength burns to the peripheral retina to reduce the ischemic retina that brings about angiogenesis
  • Indications:
    • High risk severe PDR
    • Rubeosis w/ or w/o neovascular glaucoma
    • Moderate to severe neovascularization not involving the optic disc
    • Widespread retinal ischemia & capillary non-perfusion
    • PDR during pregnancy
    • Preproliferative retinopathy in the second eye w/ severe PDR in the other eye
  • Complications:
    • Pain during treatment
    • Transient increases in IOP
    • Corneal abrasions
    • Mydriasis due to damage of nerves in the uveal tract
    • Macular edema
    • Visual acuity &/or field loss
    • Loss of dark adaptation
    • Choroidal detachment or hemorrhage
    • Exudative retinal detachment
    • Subretinal neovascularization
    • Vascular occlusions
    • Lens opacities
    • Vitreous hemorrhage from regression of neovascular tissue

Vitrectomy

  • Surgical removal of the vitreous gel, blood & fibrovascular tissue
  • Treatment option for advanced DR
    • Shown to increase vision-related quality of life in patients w/ PDR
  • Indications:
    • Severe non-clearing vitreous hemorrhage w/in 3 mths of type 1 DM
    • Severe PDR or chronic or diffuse DME not responding to aggressive & extensive panretinal photocoagulation
    • Traction retinal detachment recently involving the macula
    • Combined traction & rhegmatogenous detachment
    • Progressive fibrovascular proliferation
    • Rubeosis iridis & vitreous hemorrhage w/ opacity preventing adequate laser
  • Complications:
    • Recurrent vitreous hemorrhage
    • Endophthalmitis
    • Glaucoma
    • Retinal tear/detachment
    • Rubeosis iridis
    • Premature development of cataract
  • Pars plana vitrectomy has been found to have improved visual acuity when substantial vitreomacular traction is present in selected patients w/ diffuse CSME that is unresponsive to previous macular laser photocoagulation although more evidence are still needed
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