1. 1PRESENTED BY,SONALI DIWATE B.M. PHARM.(PHARMACOLOGY)GUIDED BY,PROF. CHANSHETTI R. R.PE SocietysModern College of Pharmacy (for ladies),Moshi, Pune.

2. To Recognize the importance of diabetic retinopathy as a publichealth problem. To Discuss diabetic retinopathy as a leading cause of blindness. To Identify the risk factors for diabetic retinopathy. To Describe and distinguish between the stages of diabeticretinopathy. To Discuss various treatment & therapies for diabetic retinopathy.2 3. Introduction to Diabetic Retinopathy Types of Diabetic Retinopathy Pathogenesis Risk factors Diagnosis Management of DR Biomarkers of DR Conclusion References3 4. Diabetes is a chronic disorder characterized by high blood glucoselevels. Diabetes results from defects in the body's ability to produce and/oruse insulin.Types Type 1 diabetes- is usually diagnosed in children and young adults, andwas previously known as juvenile diabetes. In type 1 diabetes, the bodydoes not produce insulin. 5% of people with diabetes have this form of thedisease. Type 2 diabetes- is either the body does not produce enough insulin orthe cells ignore the insulin. This is the most common form of diabetes.4 5. 5 6. MECHANISM6Eye problems Blurred vision Double vision Cloudy vision Floating spots in visual field Curtain like shadow in eye Redness of eyes 7. Diabetic retinopathy is caused due to changes in bloodvessels of the retina. When these blood vessels are damaged, they may leakblood and grow fragile new vessels. When the nerve cells are damaged, vision is impaired. These changes can result in blurring of your vision,hemorrhage into your eye.7 8. 8 9. Non-proliferative DiabeticRetinopathyThe lesions in the retina at this stageinclude: Micro-aneurysms, Small Dot And Blot Hemorrhages, Splinter Hemorrhages, Intraretinal MicrovasculaAbnormalities (IRMA) And CottonWool Spots.Proliferative DiabeticRetinopathy The unchecked progression ofproliferative diabetic retinopathycan lead ultimately to tractionalretinal detachment, which may ormay not involve the macula. Vitreous hemorrhage may requireultrasonography to determine if atractional (retinal break or hole)retinal detachment is present.9 10. 10 11. 1. Mild Nonproliferative Retinopathy.At this earliest stage, microaneurysms occur. Theyare small areas of balloon-like swelling in theretina's tiny blood vessels.2. Moderate Nonproliferative Retinopathy.As the disease progresses, some blood vessels thatnourish the retina are blocked.11 12. 3. Severe Nonproliferative Retinopathy.Many more blood vessels are blocked, deprivingseveral areas of the retina with their blood supply.4. Proliferative Retinopathy.At this advanced stage, the signals sent by the retinafor nourishment which trigger the growth of newblood vessels.This condition is called proliferative retinopathy.12 13. The blood vessels become tortuous, i.e. they become dilated andtake on a serpentine path. The dilation is caused by radial stretchingof the blood vessel and the serpentine path occursbecause of longitudinal stretching. In persons with diabetes, increased arteriolar tortuosity wasassociated with mild and moderate stages of DR. This suggests thatretinal vascular tortuosity might be an early indicator ofmicrovascular damage in diabetes13 14. Diabetic retinopathy is the result of micro vascular retinalchanges. Hyperglycemia-induced intramural pericyte death andthickening of the basement membrane lead to incompetence ofthe vascular walls. These damages change the formation of the blood-retinalbarrier and also make the retinal blood vessels become morepermeable.14 15. 15 16. Duration of Diabetes Poor control of Diabetes Pregnancy Hypertension Nephropathy Obesity & Hyperlipidemia Smoking16 17. Diabetic retinopathy is detected during an eye examinationthat includes: 1. Visual acuity test 2. Pupil dilation 3. Ophthalmoscopy 4. Fundus Fluorescein angiography(FFA)17 18. 181.Lasersurgery2.InjectionAnti-VEGFinto the eye3.Vitrectomy4.OCT 19. 19Laser therapy to seal leaking bloodvessels (focal laser)Laser therapy to reduce retinal oxygendemand (scatter laser)Surgical removal of blood from the eye(vitrectomy) 20. 20 21. 21 22. 22 23. TyrosinekinaseinhibitorsAnti-VEGFAntibodyderivativeMonoclonalantibodies23Avastin(Bevacizumab)Lucentis(Ranibizumab)Tykerb( Lepatinib)sutent(sunitinib) 24. Vascular endothelialgrowth factor (VEGF)Binds to theTyrosine KinaseStimulate cellularresponsesAngiogenesisIncrease in migration ofendothelial cellsIncrease in mitosis ofendothelial cells24THROUGHTRANSPHOSPHORYLATION 25. ADVERSE DRUG REACTIONS EYE IRRITATION EYE DISCOMFORT SWELLING OFFACE,LIPS,TOUNGUE BREATHING DIFFICULTY AVOIDED IN PREGNANCYCLINICAL IMPLICATIONS BREAST CANCER RHEMATOID ARTHRITIS AMD25DRUG INTERACTION DO NOT GIVE ASPIRIN 26. 26 27. 27 28. Control blood sugarMaintain a consistent intake of carbohydrate foods at meals Bread/starch/grain, milk/yogurt, fruit/fruit juice and sweetscontain carbohydrate Control blood pressureIncrease intake of fruits, vegetables, whole grains, low-fat or fat-freedairy products and nuts, Decrease sodium intake,Moderate alcohol intake Control cholesterol levelsChoose foods moderate in fat and low in saturated fat, cholesteroland trans fat Get regular physical activityGet moderate or vigorous activity most days of the weekcombined with resistance training Lose weight if overweight Have regular physician and dietitian visits Have regular comprehensive and dilated-eye exams 28 29. A biomarker is a substance or activity that can be measuredand serves as a marker of a specific biological activity. A biomarker may be a substance measured in the blood orurine. It improve the understanding of a disease process. It predicts disease severity/complications. Improves treatment targeting. Monitor treatment efficacy.29 30. NovelBiomarkersEg.fibrinogenInflammatorybiomarkersEg. C- ReactiveProtein (CRP)Serum lipidsEg. Tri-glyceridesOtherBiomarkersEg.(VEGF)30 31. Study of Association of Serum Lipids with DiabeticRetinopathy in Type 2 Diabetes MellitusAlpana Mathur, *Rishi Mathur31 32. In 2009-10 out of 285 million people suffering from Type II Diabetes Mellitus. Diabetes along with its fatal complications, is one of the leading cause ofmortality and morbidity. Chronic complications of DM includes --- Macro Vascular Complications like coronary artery disease,cerebrovasculardisease and peripheral vascular disease Micro Vascular Complications like retinopathy, nephropathy and neuropathy. Risk Factors like duration of diabetes, glycemic control (HbA1c), systolic bloodpressure, dyslipedemias, smoking and microalbuminurias have been linkedwith complications of DM.32 33. Various studies have shown a positive correlation between elevatedserum lipids (TG, LDL,TC) and macro vascular complications likeischemic heart disease. Studies of association of elevated serum lipids with micro vascularcomplications like diabetic retinopathy (DR) have shown varyingresults. In this study attempt has been made to quantify and specify the roleof various components of serum lipids with the prevalence of DR.33 34. 34150 subjects are takenInformed consent is obtainedMedical history & clinical examination were takenOvernight fasting is done & samples are takenAgain samples are taken after meal (2hr)FBS & PPBS were estimated by glucose peroxidasemethodFunduscopy were done by using homatropineSubjects with symptoms like micro aneuysm,cottonwool spots are observedLabeled as DR 35. The 150 subjects were divided into three groups as follows:Group I: 50 subjects with FBS 110mg% and PPBS140mg% without any drug or insulin, were takenas control group.Group II: 50 subjects with history of DM for more than 5years but no signs of DR.Group III: 50 subjects with DM for more than 5 years andsigns of DR.35 36. Results show that with increase in the duration of diseasethere was an increase incidence of DR (p