Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is a significant cause of blindness due to chronic hyperglycemia in combination with high blood pressure. It divides into nonproliferative and proliferative forms.

Glucose Abnormalities

May worsen in pregnancy and other conditions (eg, steroid use) when blood glucose control is impaired.

Prevention & Management

Prevention and management involves control of blood glucose and pressure.
Screen all patients with diabetes annually/pregnant patients every trimester.
See below regarding proliferative retinopathy management: (anti-VEGF drugs), panretinal laser photocoagulation, vitrectomy.

Diabetic macular edema (DME)

Diabetic macular edema refers to edema at the macula (the site of central vision). It can occur at any stage of diabetic retiniopathy (nonproliferative or proliferative) and is a key cause of loss of vision.

Stages of Diabetic Retinopathy

Nonproliferative diabetic retinopathy (NDR)

Increased capillary permeability with hemorrhages (dot/blot hemorrhages), microaneurysms, exudates, macular ischemia and retina thickening from leaked capillary fluid.
Look for: capillary microaneurysms, hard or soft exudates, dot and blot retinal hemorrhages.

Hard exudates: Yellow particles that suggest chronic edema.
Soft exudates (aka, cotton-wool exudates): white/fuzzy-looking areas that represent ares of microinfarction of the nerve fiber layer.

Treat edema with antivascular endothelial growth factor drugs, focal laser, intraocular corticosteroid implants, or vitrectomy.

Proliferative retinopathy

Ischemia stimulates retinal cell release of vascular endothelial growth factor (VEGF) release to stimulate growth of blood vessels.
Look for them in the interface between perfused and non-perfused retinal areas and at the optic disc.
Unfortunately, these vessels are fragile and bleed easily.
Neovascularization at the vitreous surface of the retina can lead to vitreous hemorrhage and neovascularization in the anterior segments of the eye can lead to glaucoma.
Preretinal fibrous tissue can develop and lead to retinal detachment.
Patients may present with complaints of blurred vision/floaters/flashing lights with sudden vision loss.
Treat with antivascular endothelial growth factor drugs, panretinal laser photocoagulation, vitrectomy.

Image Reference

Diabetic Retinopathy