Optom. Sameep Adhikari

Diabetic Retinopathy

05/01/2023 2DR

Series of retinal changes that occur in patients with DM

Serious sight-threatening complication of DMMost common cause for legal blindness Common in type I DM than type II

Introduction

05/01/2023 3DR

Duration of DM:Mostly >10 yrs

Poor metabolic controlPregnancy HypertensionNephropathyHereditySmokingObesity

Risk Factors

05/01/2023 4DR

Microangiopathy

Microvascular occlusion

Retinal ischaemia

Arteriovenous shunt

formationNeovascularisation

Capillary leakage and

haemorrhage

Microaneurysm

Retinal oedema

Hard exudates

Pathophysiology

05/01/2023 5DR

Early stage:Asymptomatic

Advance stage:Seeing spots or floaters in visual fieldBlurred visionDistorted visionDifficult in seeing well at night

Symptoms

05/01/2023 6DR

Background Diabetic Retinopathy:Microaneurysms:

Tiny, round, red dots located in INLFFA shows tiny hyperfluorescent dots representing

non-thrombosed microaneurysmsHard exudates:

Waxy-yellowish lesions with distinct margins at OPL

FFA shows hyperfluorescence due to blockage of background choroidal fluorescence

Classification

05/01/2023 7DR

Retinal oedema:Initially, located between OPL and INLBest detected by fundus examination with Goldman

lensFFA shows diffuse late hyperfluorescence due to

retinal capillary leakageHaemorrhage:

Intra retinal haemorrhage from venous end of capillariesDot and blot haemorrhage

Retinal nerve fibre layer haemorrhage due to larger pre-capillary arteriolesFlame shaped haemorrhage

05/01/2023 8DR

Management:No treatment requiredReview annuallyAssociated factors should be controlled

05/01/2023 9DR

Is BDR that shows the signs of proliferative DR

Signs:Cotton wool spots:

Local infarcts of RNFL due to blockage of pre-capillary arterioles

Small whitish superficial lesionsFFA shows hyperfluorescence

Pre-proliferative Diabetic Retinopathy

05/01/2023 10DR

Intraretinal microvascular abnormalities(IRMA):Shunts that runs from arterioles to venules by-

passing capillary bedFFA shows focal hyperfluorescence at areas of

capillary closureVenous changes:

Dilatation of veinsVenous looping

Arterial changes:NarrowingSilver-wiring

05/01/2023 11DR

Dark blot haemorrhage:Haemorrhagic retinal infarcts located within

middle layers of retinaManagement:

Reviewed in regular basisPhotocoagulation can be done if follow up is

not possible

05/01/2023 12DR

Involvement of fovea by oedema, hard exudates or ischaemia

Classification:Focal exudative

Well-circumscribed retinal thickening along with hard exudates

FFA shows focal hyperfluorescence due to leakage and macular perfusion

Diffuse exudativeDiffuse retinal thickening associated with cystoid changesFFA shows widespread spotty hyperfluorescence of

microaneurysms and late diffuse hyperfluorescence which shows flower petal pattern , if CMO is present

Diabetic maculopathy

05/01/2023 13DR

Ischaemic:Associated with pre-proliferative DRFFA shows capillary non-perfusion at fovea

Mixed:Characterized by both ischaemia and exudation

05/01/2023 14DR

Clinically significant macular oedema(CSME):

Diabetic maculopathy can lead to CSME if present with,

Retinal oedema within 500µm centre of foveaHard exudates within 500µm centre of fovea

and associated with adjacent retinal thinkingRetinal oedema, one disc diameter or larger in

size, at least a part of which is within one disc diameter of foveal centre

Management:Argon laser photocoagulationVitrectomy

05/01/2023 15DR

DR in long run can lead to Proliferative DRSigns:

Neovascularisation is hallmark of proliferative DR

Neovascularisation may be;NVD- New vessels at discNVE- New vessels elsewhere

FFA detects neovascularisation in early stage and shows late hyperfluorescence due to leakage from new vessels

Management:Panretinal photocoagulation

Proliferative Diabetic Retinopathy

05/01/2023 16DR

05/01/2023 17DR

Serious sight threatening complication of DRSome complications are:

Pre-retinal haemorrhageTractional retinal detachmentRubeosis iridis

Management:Pars-plana vitrectomy

Advanced Diabetic Eye Disease

05/01/2023 18DR

What is his major complaintsWhether he has blurred vision or notWhether he has distorted vision or notWhether he is seeing floaters or notWhether he can appreciate black spots while seeingWhether he is suffering from DM or notIf yes, since whenWhether he is suffering from hypertension or any other

systemic diseaseWhether his family members had DR or any similar

symptomsHis blood sugar report!!

History taking

05/01/2023DR 19

Thank you…