Diabetic Eye diseases

Diabetic Retinopathy

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Stages of diabetic retinopathy

• Background• Preproliferative• Proliferative• Maculopathy

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Stages of diabetic retinopathybriefly

• Background : dot haemorrhages (microaneurysms), blot haemorrhages, hard exudates.

• Pre-proliferative: all of above, plus soft exudates (cotton wool spots), flame hemorrhages, venous beading and loops.

• Proliferative: all of the above, plus new vessel formation on retina or iris (rubeosis iridis), retinal detachment, pre-retinal or viterous haemorrhage, glaucoma (with rubeosis iridis).

• Maculopathy: hard exudates or maculae (sometimes forms rings).

The natural history of retinopathy • Diabetes causes increased thickness of the capillary basement

membrane and increased permeability of the retinal capillaries.• Aneurismal dilation may occur in some vessels, while others become

occluded.• These changes are first detectable by fluoresce in angiography: a

fluorescent dye is injected into an arm vein and photographed in transit through the retinal vessels.

• This technique is not necessary to screen effectively for retinal diseases.• After 20 years of Type Diabetes, almost all patients have some

retinopathy and 60% progress to sight-threatening retinopathy• Without treatment 50% of patients become blind within 5 years. (20+5).

Non-proliferative/background retinopathy

Pre-proliferative Retinopathy

Proliferative Retinopathy

Maculopathy

The actions needed in diabetic retinopathy

• Non-proliferative/background:Annual screening only • Pre-proliferativeNon-urgent referral to an ophthalmologist• ProliferativeUrgent referral to an ophthalmologist.• Maculopathy Urgent referral

Management/Treatment• There is no specific treatment for diabetic retinopathy• Management of Diabetes (Diet, Oral hypoglycaemic agents,

Biguanides and Insulin).• Smoking and hypertension worsen the rate of progression

and need treatment.• Development or progression of retinopathy may be

accelerated by rapid improvement in glycaemic control, pregnancy and those with nephropathy, and these groups need frequent monitoring.

• Early referral is essential

Management

• Maculopathy and proliferative retinopathy are often treatable by retinal laser photocoagulation. In the latter condition, early effective therapy reduces the risk of visual loss by about 50%.

Laser Treatment

Laser Treatment

• During this treatment, inside a slit lamp is where your chin and forehead will initially be positioned. This device is really a microscope which utilizes a line of light, or perhaps a slit, to assist your physician in clearly viewing the portions from the vision that will be operated on. Next, your physicians will locate the lens more than your cornea. This can assist the laser concentrate about the retina. You might see flashes of bright light throughout the process.

Laser Treatment

• Laser photocoagulation is definitely an outpatient process. You’ll be in a position to go home afterwards, but you’ll have to arrange for transportation since you probably will not be fit to drive instantly following surgery. As a matter of fact, for about 24-hours following your procedure, your vision might be hazy or blurry.

Laser Treatment

• Simply because laser photocoagulation entails tiny burns to seal the capillaries, little spots might appear inside your area of vision following the process. These little spots usually fade and disappear with time. If your vision was blurry prior towards the laser photocoagulation procedure, you might not totally recover obvious vision.

Laser Treatment

• Even when the laser photocoagulation process successfully corrects the leaking bloodstream vessels, new leaks might happen. For this reason, it’s imperative that diabetic retinopathy patients used to manage their bloodstream sugar and have regular vision examinations from the qualified ophthalmologist.

Diabetic Retinopathy Surgery• Sometimes, a vitreous hemorrhage can obvious up on its

personal. If vision doesn’t improve, vitrectomy surgery might be required. A vitrectomy is really a surgical process that’s performed to get rid of the clouded vitreous gel within the center from the vision. The gel is replaced having a answer that’s comparable towards the makeup of healthy, obvious vitreous matter. This diabetic retinopathy therapy has a really higher achievement rate for improving vision.Vitrectomy surgery might also be utilized to get rid of scar tissue remaining like a outcome of retinal detachment. As soon as the scar tissue is no longer pulling about the retina, the retina will generally settle back again into location and flatten out, that will enhance vision.