Diabetic Retinopathy

1. Diabetic
retinopathy
Dhaneshwar pal
Opto. 5th sem.

2. Content
 Diabetes
 Definition
 Risk factors
 Pathogenesis
 Classification : proliferative / non-proliferative
 Sign & symptoms
 DDx & other ocular complication of DM Treatment
 Prognosis and follow up

3.  Group of common metabolic disorders
 Caused by a complex interaction of genetics and environmental factors
 Lack of insulin hyperglycemia
 Diagnostic criteria : Fasting plasma glucose > 126 mg/dl
 Type 1 DM – Insulin-dependent diabetes (IDDM)
Results from pancreatic beta-cell destruction, usually leading to absolute or near total
insulin deficiency
 Type 2 DM - Non-insulin-dependent diabetes (NIDDM)
 Variable degrees of insulin resistance and impaired insulin secretion, resulting in
hyperglycemia and other metabolic derangements due to insufficient insulin action.
Diabetic mellitus

4. Diabetes mellitus
Long-standing hyperglycemia leads to multiple organ
damage
Macrovascular complications
• Stroke
• Heart disease and hypertension
• Peripheral vascular disease
• Foot problems
Microvascular complications
Diabetic eye disease : retinopathy and cataracts
• Renal disease
• Neuropathy
• Foot problems

5. Risk factor
• Duration of diabetes
• Most important
Pt diagnosed before age 30 yr
50% DR after 10 yrs
90% DR after 30 yrs
• Poor metabolic control
• Less important, but relevant to development and
progression of DR
HbA1c ass. With inc. risk
Pregnancy
Ass with rapid progression of DR
Predicating factors : poor pre-pregnancy control of DM

6. Pathogenesis
Microvascular leakage
Microvascular occlusion

7. Microangiopathy
• Microvascularocclusion
• Microaneurysm
• Capillary leakage and haemorrhage
Retinal ischemia
• Retinaledema&
hard exudates
• AV shunt formation
• Neovascularisation
Microvascular leakage

9. • Classification
Non-proliferative diabetic retinopathy (NPDR)
Proliferative diabetic retinopathy (PDR)
• Non-proliferative diabetic retinopathy
• Mild NPDR
• Moderate NPDR
• Severe NPDR

10. Sign of NPDR
• Microaneurysm
• Retinal haemorrhage
• “Dot or Blot” Spot
• “Flame or Splinter shape” haemorrhage
• Hard exudate
• Cotton wool Spot
• Venous beading
• Intra-retinal microvascular abnormalities
(IRMA)

11. microaneurysm
• These are the most characteristics of ocular lesions.
• It affects the smaller blood vessels by damaging the capillary wall.
• They found at macular area during fluorescein angiography.
• They are seen on at inner nuclear layer
• They looks like small, oval or round dilataion ranging from 20-200 micron in
size

12. Haemorrhages
Round-shaped ‘ dot and blot’ haemorrhages
occur due to rupture of micro aneurysms in the
inner nuclear layer
HARD EXUDATES:
these are seen all over the posterior pole.
They are white or yellow coloured , waxy looking patches
(hyaline and lipids Situated between the inner plexiform
and inner nuclear layer.
Hyperlipidemia may correlate with development of
exudates

13. Cotton wool
spots:
• White fluffy lesions in nerve fiber layer
• Result from occlusion of retinal pre-capillary arterioles
• Also called "soft exudates" or "nerve fiber layer
infarctions“
• Fluorescein angiography shows no capillary perfusion in
the area of the soft exudate
• Very common in DR, esp if pt with HT

14. irma
Intraretinal microvascular abnormalities (or IRMAs)are shunt vessels and appear
as abnormal branching or dilation of existing blood vessels (capillaries) within
the retina that act to supply areas of non-perfusion in diabetic retinopathy. .

15. Picture with
Caption Layout
Caption

16. •ONLY ONE MICROANEURYSM
Mild NPDR
• More MICROANEURYSM
• Scattered hard exudates
• Cotton wool spots
Moderate NPDR
• 4-2-1
• rule4 quadrants of severe retinal hemorrhages
• 2 quadrants of venous beading
• 1 quadrant of IRMA
• Very severe NPDR more than 1 of above
Severe NPDR

18. Diabetic
maculopathy
Involvement of the fovea by oedema and /or hard
exudates is the most common cause of Visual
impairment in diabetic patients