+ All Categories
Home > Health & Medicine > Diabetic retinopathy

Diabetic retinopathy

Date post: 24-Jun-2015
Upload: devashree-n
View: 789 times
Download: 3 times
Share this document with a friend
Opthalmologists view.
Embed Size (px)
Popular Tags:
of 44 /44
Page 1: Diabetic retinopathy


Page 2: Diabetic retinopathy
Page 3: Diabetic retinopathy
Page 4: Diabetic retinopathy

Progressive dysfunction of the retinal blood vessels caused by chronic hyperglycaemia.


Page 5: Diabetic retinopathy

1. Hyperglycaemia Duration of diabetes - 50% develop DR after 10 yrs- 70 % after 20 yrs- 90 % after 30 yrs 2. Hypertension 3. Hyperlipidaemia4. More in females than males5. Pregnancy may accelerate DR6. Smoking, Obesity, Anaemia7. Poor metabolic control8. Hereditary – more on proliferative DR

Risk Factors

Page 6: Diabetic retinopathy
Page 7: Diabetic retinopathy
Page 8: Diabetic retinopathy
Page 9: Diabetic retinopathy
Page 10: Diabetic retinopathy
Page 11: Diabetic retinopathy

Classification of Diabetic Retinopathy

• Non-proliferative diabetic retinopathy

I. Mild nonproliferative retinopathyII. Moderate nonproliferative retinopathyIII.Severe nonproliferative retinopathyIV.Very severe nonproliferative retinopathy

• Proliferative diabetic retinopathy

• Diabetic maculopathy

• Advanced diabetic eye disease

Page 12: Diabetic retinopathy

No retinopathy

Page 13: Diabetic retinopathy

I. Mild nonproliferative retinopathy

• Atleast one microaneurysm or intraretinal haemorrhage

• Hard/ Soft exduates may or may not be present

Page 14: Diabetic retinopathy
Page 15: Diabetic retinopathy

II. Moderate nonproliferative retinopathy

• Micro aneurysms / intraretinal haemorrhages in 2 or 3 quadrants

• Early mild IRMA Intra retinal Microvascular abnormalities

• Hard / Soft exudates may or may not be present

Page 16: Diabetic retinopathy
Page 17: Diabetic retinopathy
Page 18: Diabetic retinopathy

III. Severe nonproliferative retinopathy

• Four quadrants of severe micro aneurysms / intraretinal haemorrhages

• Two quadrants of venous bleeding

• One quadrant of IRMA changes

Any one of the following :

Page 19: Diabetic retinopathy
Page 20: Diabetic retinopathy
Page 21: Diabetic retinopathy

IV. Very severe nonproliferative retinopathy

• Four quadrants of severe micro aneurysms / intraretinal haemorrhages

• Two quadrants of venous bleeding

• One quadrant of IRMA changes

Any two of the following :

Page 22: Diabetic retinopathy

Proliferative diabetic retinopathy


PDR without HRC PDR with HRC

NVD ¼ to 1/3 of disc area with or without VH or PRH

NVD < ¼ disc area with VH or PRH

NVD < ¼ disc area with VH or PRH

Page 23: Diabetic retinopathy
Page 24: Diabetic retinopathy

Extensive vitreous haemorrhage obscuring most of fundus (white circle)

Page 25: Diabetic retinopathy
Page 26: Diabetic retinopathy
Page 27: Diabetic retinopathy
Page 28: Diabetic retinopathy
Page 29: Diabetic retinopathy

Diabetic Maculopathy

On Slit lamp examination with 90D lens :

1. Thickening of retina at or within 500 micron of the centre of fovea

2. Hard exudates at or within 500 micron of the centre of fovea associated with adjacent retinal thickening

3. Development of a zone of retinal thickening one disc diameter or larger in size, at least a part of which is within one disc diameter of foveal centre.

Page 30: Diabetic retinopathy
Page 31: Diabetic retinopathy

Maculopathy within 1 disc diameter of the fovea.

Page 32: Diabetic retinopathy

Advanced diabetic eye disease

1. Persistent vitreous haemorrhage

2. Tractional retinal detachment

3. Neovascular glaucoma

Page 33: Diabetic retinopathy
Page 34: Diabetic retinopathy


1. Urine examination2. Blood sugar estimation3. 24 hour urinary protein4. Renal function tests5. Lipid profile6. Haemogram7. Glycosylated Haemoglobin (HbA1C)8. Fundus Fluorescein angiography – to

elucidate areas of neovascularisation, leakage and capillary nonperfusion

9. Optical Coherence Tomography to study detailed structural changes in diabetic maculopathy

Page 35: Diabetic retinopathy

Prevention1.Primary Prevention –

Strict glycemic control, Blood pressure control, correction of dyslipidaemia, control of associated anaemia, control of hypoproteinemia

2.Secondary Prevention – Annual eye exams

3.Tertiary Prevention – Retinal laser photocoagulation , Vitrectomy

Page 36: Diabetic retinopathy

Treatment of Diabetic Retinopathy

1. Anti – vascular endothelial growth factors

2. Others under evaluation – Protein Kinase C inhibitors, Aldose reductase, ACE inhibitors, Antioxidants such as vitamin E

3. Role of intravitreal steroids – Flucinolone acetonide intravitreal implant, Inj. Triamcinolone intravitreal

Page 37: Diabetic retinopathy

Laser Photocoagulation

Page 38: Diabetic retinopathy
Page 39: Diabetic retinopathy
Page 40: Diabetic retinopathy


Page 41: Diabetic retinopathy
Page 42: Diabetic retinopathy

September 16, 2014

Eylea Granted Breakthrough Therapy for Diabetic RetinopathyFood and Drug Administration (FDA) has granted Eylea (afilbercept) Injection Breakthrough Therapy designation for the treatment of diabetic retinopathy in patients with diabetic macular edema (DME).

Eylea is a vascular endothelial growth factor (VEGF) inhibitor designed to block the growth of new blood vessels and decreases vascular permeability in the eye by blocking VEGF-A and placental growth factor (PlGF), two growth factors involved in angiogenesis.

Eylea helps prevent VEGF-A and PlGF from interacting with their natural VEGF receptors as shown in preclinical studies.

Eylea is already approved for the treatment of neovascular (wet) age-related macular degeneration (AMD) and macular edema following central retinal vein occlusion (CRVO).

Latest Treatment modalities for Diabetic Retinopathy

Page 43: Diabetic retinopathy

Human trials are set to begin for a new medication, currently called KVD001, which treats diabetic macular edema, a form of diabetic retinopathy.

Human trials begin for promising diabetic retinopathy treatmentFri, 05 Sep 2014

KVD001 is an intravitreal plasma kallikrein inhibitor drug that is given byinjection into the eye. Whilst injections into the eye may sound painful, in practice they are not as eye-watering as they sound.

There is currently only one medication, Lucentis, has been officially licensed for treatment of diabetic macular edema. Having another medication such as KVD001 would give doctors more choice over which treatment to give and, because it works in a different way to Lucentis, it means that it could help save thesight of people for whom Lucentis is not effective.

KVD001 has been developed by KalVista Pharmaceuticals, a company in Hampshire. The clinical trials, which will be run across five different centres within the United States, are being funded by the type 1 diabetes charity, the JDRF.

Page 44: Diabetic retinopathy


Diabetic Retinopathy is preventable through strict glycemic control and annual dialated eye exams by an opthalmologist.