Diabetic Eye Clinic

Diabetic Eye Clinic

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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

  • DR 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 D. R.
  • 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 hge:

  • Due to rupture of wall of capillary or Microaneurysm, giving rise to intra retinal hge.
  • If the hge is deep (i.e. in the inner layer of OPL) it is usually is round or oval (dot/ blot hge)

Flame Shaped Hge

  • Arise from superficial precapillary arterioles.
  • The hge is more superficial & in the nerve fiber layer, it takes a flame/ splinter shape as they follow 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 Microaneui ysrn frequently at posterior pole.
  • These are sign of current/previous Macular edema.


Cotton wool Spot (soft exudates):

  • They are white fluffy lesion in
    nerve fiber layer.
  • Caused by capillary occlusion at
    NFL due to infarction.

Intraretinal microvascular abnormality (IRMA):

  • Abnormal dilated, tortuous retinal capillaries that act as a shunt between arterioles & venules.
  • It’s 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

 MILD NPDR  MA, 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 —
MA, retinal hge in all four quadrants
Venous changes in 2/ 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 1/3′ of Optic disc diameter with/ without hge
  • Less than 1/3* of optic disc diameter with hge (preretinal & vitreous hge)


◉ New vessel Elsewhere in Fundus:

  • More than K of Optic disc diameter with/ without hge
  • Less than K of Optic disc diameter with hge. (preretinal & vitreous hge)

Clinically Significant Macular Edema

Modified Airlie- House criteria:

  • Retinal edema within 500 micron of central fovea
  • HE 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.

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
  • OCT

Laser Treatment:

  • Focal Laser
  • Grid Laser
  • Pan Retinal Photocoagulation


Intra Vitreal Injection:

  • Anti- VEGF injection

Laser

Indication
◉ Grid + focal laser — CSME
◉ PRP:
   ◉ PDR

       High risk
       Early PDR —

  • In pts with poor compliance
  • During pregnancy
  • Pt with systemic disease
  • Pending cataract surgery/ YAG laser capsulotomy
  • Rubeosis iridis
  • Severe/ very severe NPDR (irregular F/U)

Laser (M/A)

Focal laser
◉ Burns only Microaneurysm

Grid laser

  • Around the edema except the Foveolar avascular zone.


PRP:

  • lt burns the viable retina which is suffering from ischemia, thus reduces the oxygen demand
    of retina & prevents hypoxia.
  • As it burns the ischemic retina, so reduces YEGF secretion by the ischemic retina.

Know the Director

Dr. Varun Gogia, an AIIMSonian (2002-2007), is an NTSE and KYPY scholar, securing a Meritorious position in the competitive Residency exams. He chose Ophthalmology out of his love and passion for the subject at the prestigious, Dr. Rajendra Prasad centre for Ophthalmic Sciences, AIIMS, the apex Ophthalmology training institute of the country(2008-2011). His Dedication and commitment towards patients were reflected when he topped MD final exams and was awarded with the best Junior Resident award for the same.

Following this he had the opportunity to train in Vitreoretinal, Uvea and ROP and got immense surgical training under the able leadership of his distinguished teachers.(2011-2014).

Monday : 08am - 12pm
Tuesday : Free Day
Wednesday : 08am - 12pm
Thursday : 08am - 12pm
Friday : 08am - 12pm
Sat & Sun: Closed