Tuesday, 24 February 2009

diabetic retinopathy 2

remember diabetic retinopathy is different from diabetic maculopathy.

clinical types of diabetic retinopathy:

1-non-proliferative DR
formally classified as:background retinopathy
pre-proliferative retinopathy.
NPDR is further classified to:
mild->microaneutysm,dot and blot hge in all 4 quadrants
moderate->4 blots in one qudrant &/or cotton wool spots.
severe->severe hge in 4 quadrants,
or venous besding in 2 quadrant,
or IRMA in one quadrant.
very severe->any 2 of severe.

2-proliferative DR:
in addition to NPDR there is neovasculaization.
this can be in the disc (PDR with NVD) or elsewhere (PDR with NVE)

Diabetic maculopathy:
retinopathy in and around the macula
usually in form of exudate or oedema
significant visual impairment.

advance diabetic eye disease:
include retinal detachment and vitreous haemmorrhage.

NPDR mild ->annual screening
NPDR moderate ->non urgent ophthalmoloyg referal.
NPDR severe ->non urgent ophthalmoloyg referal.
NPDR very severe ->urgent ophthalmoloyg referal.
PDR ->urgent ophthalmoloyg referal.
muculopathy ->urgent ophthalmoloyg referal.

remember:tell the examiner that you would like to:
ask the patient about sight disturbance
diabetes control
evidance of other micro or macrovasculr complications of DM

for all you need to know click on this link of the royal college of ophthamologists.


  1. dot haemorrhages are due to capillary microaneurysms.
    blot haemorrhage are due to Leakage of blood into the deeper layers of the retina .
    hard exudates is due to exudation of fluid rich in lipids and protein.
    cotton-wool spots represent oedema resulting from retinal infarcts.

  2. pathophysiology:
    hyperglycaemia results in microangiopathy in the retinal capillaries .This result in microanuerysim fromation and increase vascular permeability with leakage into the retina,as more more capillaries and aterioles become occluded ischemia wil result.the retina will respond by abnormal blood vessel formation.these are usually quite fragile and bleed easily into the retina and result in visual impairment and loss.

  3. Laser photocoagulation uses the heat from a laser to seal or destroy abnormal, leaking blood vessels in the retina. The ophthalmologist make hundreds of laser burns on the retina to stop the blood vessels from growing.
    One of two approaches may be used when treating diabetic retinopathy:
    1-Focal photocoagulation: used to seal specific leaking blood vessels in a small area of the retina, usually near the macula.
    2-Scatter (pan-retinal) photocoagulation:used to slow the growth of new abnormal blood vessels that have developed over a wide area of the retina.