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