DIABETIC RETINOPATHY
It is the “disease of the retina” caused by microangiopathy due to long term effect of diabetes leading to progressive damage of the retina & blindness.
Most common cause of severe bilateral visual loss in working age group.
DIABETIC RETINOPATHY
It is the “disease of the retina” caused by microangiopathy due to long term effect of diabetes leading to progressive damage of the retina & blindness.
Most common cause of severe bilateral visual loss in working age group.
Risk Factors
- Age at diagnosis of diabetes
- Duration of diabetes
- Poor metabolic control
- Pregnancy
- Hypertension
- Nephropathy
- Others – smoking, obesity, hyperlipidemia, anemia
Pathophysiology
- Diabetic Retinopathy is a microangiopathy primarily affecting the precapillary arterioles, capillaries,
venules and post capillary venules. - The basic component of damaging process are microvascular occlusion & microvascular
leakage.
Capillary Changes
- Degeneration & loss of pericytes
- Thickening of Basement membrane
- Damage & proliferation of endothelial cells
Hematological Changes:
- Deformation of RBC & rouleaux formation
- Increased plasma viscosity
- Increased platelet stickiness & aggregation
Microaneurysm
- Earliest sign of Diabetic Retinopathy.
- Appear as tiny red dots.
- It is focal saccular dilatation of capillary walls where pericytes are absent.
- Located in the outer plexiform layer & inner nuclear layer.
- Usually at posterior pole, especially temporal to the fovea.
- In FFA — present at the edge of area of capillary non- perfusion (hyper fluorescence dots)
Dot & Blot Haemorrhage:
- Due to rupture of wall of capillary or microaneurysm, giving rise to intra retinal haemorrhage.
- If the haemorrhageis deep (i.e. in the inner layer of Outer Plexiform Layer) it is usually is round or oval (dot/ blot haemorrhage)
Flame Shaped Haemorrhage
- Arise from superficial precapillary arterioles.
- The haemorrhage is more superficial & in the nerve fiber layer, it takes a flame/ splinter shape as it follows the architecture of the nerve fiber layer.
Exudates
Hard Exudates:
- These are yellow deposits of lipid, lipoprotein & lipid filled macrophages within the outer plexiform & inner nuclear layer.
They are arranged in clumps or form circinate pattern around the macula frequently at posterior pole. - These are signs of current/previous Macular edema.
Cotton wool Spot (soft exudates):
- They are white fluffy lesions in the
nerve fiber layer. - Caused by capillary occlusion at
nerve fiber layer due to infarction.
Intraretinal microvascular abnormality (IRMA):
- Abnormal dilated, tortuous retinal capillaries that act as a shunt between arterioles & venules.
- It’s located within the internal limiting membrane.
Venous changes:
- In the form of “beading”, “looping” & “severe segmentation” due to venous stagnation.
CLASSIFICATION
ETDRS CLASSIFICATION:- NON PROLIFERATIVE DIABETIC RETINOPATHY
ETDRS CLASSIFICATION:- NON PROLIFERATIVE DIABETIC RETINOPATHY
| MILD NPDR | micro aneurysms, retinal hemorrhage, hard exudates |
| MODERATE NPDR | Mild NPDR plus cotton wool spots, venous changes & IRMA |
| SEVERE NPDR 4:2:1 rule |
Moderate NPDR plus one of — micro aneurysms, retinal haemorrhage in all four quadrants Venous changes in 2 or more quadrants IRMA atleast in 1 quadrant |
| VERY SEVERE NPDR | Two or more of the above features on severe NPDR |
Proliferative Diabetic Retinopathy:
early/ mild/ non — high risk PDR
High Risk:
◉ New vessel on Disc:
- More than 1/3rd of Optic disc diameter with/ without haemorrhage
- Less than 1/3rd of optic disc diameter with haemorrhage (preretinal & vitreous haemorrhage)
◉ New vessel Elsewhere in Fundus:
- More than 1/2 or equal to 1/2 of Optic disc diameter with/ without haemorrhage
- Less than 1/2 of Optic disc diameter with haemorrhage. (preretinal & vitreous haemorrhage)
Clinically Significant Macular Edema
Modified Airlie- House criteria:
- Retinal edema within 500 micron of central fovea
- Hard Exudates within 500 micron of fovea centralis associated with adjacent retinal thickening
- Retinal edema that is 1 disc diameter or larger, any part of which is with in 1 disc diameter of the fovea centralis.
Why us at IClinix Diabetic Eye Care?
NON MYDRIATIC FUNDUS WITH OPTOS
◉ No Dilatation Required
◉ No Blurring Of Vision After Your Visit
◉ Time Saving
◉ No Stinging, No Eye Irritation
◉ No Blurring Of Vision After Your Visit
◉ Time Saving
◉ No Stinging, No Eye Irritation
MULTISPOT LASER
◉ Less sittings
◉ More Efficient Laser Deliveries
◉ Less Pain
◉ More Efficient Laser Deliveries
◉ Less Pain
OCT ANGIOGRAPHY
◉ High Definition Imaging Of Your Retina
◉ Non Invasive Angiography Vs Conventional Angiography
◉ No Prick And Painless Angiography
◉ More Efficient Laser Deliveries
◉ Non Invasive Angiography Vs Conventional Angiography
◉ No Prick And Painless Angiography
◉ More Efficient Laser Deliveries
3D OCT
- Advance eye scan for people for all
- Captures digital photograph of layers of the retina
- Easy and Painless
- Can monitor the progression of any changes in your retina
ZEISS RETINA WORKPLACE:
see your retina profile evolve over years under ICLINIX and compare yourself how the disease is controlled. We bring the FORUM for your individualised follow ups
- Visualize integrated imaging data in seconds
- Rapid and comprehensive: Fully assess retinal structure in seconds
- Enhanced diagnosis and prognostication
MINIMALLY INVASIVE VITREORETINAL SURGERY (MIVS)
- Advanced Sutureless Vitrectomy/ Minimal Gauge Vitrectomy
- Faster Recovery
- Zero Astigmatism
1) History from patient
2) Clinical features
3) Ocular examination
◉ BCVA
◉ Slit lamp examination
• Cornea
• Iris
• lens
◉ Funduscopy
Laboratory Test:
- Blood sugar- FBS, RBS, 2HPPBS
- Serum lipid profile
- Medical evaluation of HbAlc
Ancillary Test:
- Color fundus photograph
- Fundus Fluorescein Angiography
- 3D OCT
- OCT Angiography
- OPTOS (undilated retina workup)
- ZEISS Retina Workplace
Laser Treatment:
- Focal Laser
- Grid Laser
- Pan Retinal Photocoagulation
Intra Vitreal Injection:
- Anti- VEGF injection
