Assistant professor Shalakya tantra HAMCampH Dehradun 9454908322 PART 2 2 Proliferative diabetic retinopathy 5 of DM pt more common in type 1 50 of cases after about 25 years after the onset of disease ID: 916173
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Diabetic retinopathy
Dr. Shikha Assistant professor Shalakya tantraHAMC&H Dehradun 9454908322
PART -2
Slide22. Proliferative diabetic retinopathy5% of DM pt., more common in type 150% of cases after about 25 years after the onset of diseaseFindingNeovascularization : NVD* , NVEVitreous changes- detachment, haemorrhageAdvanced diabetic eye diseaseFinal stage of Uncontrolled PDRGlaucoma (neovascularization)Blindness from persistent vitreous hemorrhage, tractional RD, opaque membrane formation,
Slide3Slide4Types of PDR1. PDR without HRC (High risk characterstics) or early PDR2. PDR with HRC or advanced PDR –NPD ¼ to 1/3 of disc with or without vitreous haemorrhage ( VH) Or preretinal haemorrhage(PRH)NVD <1/4 Of disc are with VH Or PRHNVE > ½ disc are with VH Or PRH
Slide5Neovascularization of disc
Slide6Rubeosis
iridis(neovascularisation of the iris)
Neovascular glaucoma
Slide7Slide8Tractional
retinal detachment
Vitreous hemorrhage
Slide93. DIABETIC MACULOPATHYIt effect on vision , may be associated with NPDR Or PDRClinically significant macular oedema (CSME),Hard exudates at foveaDevelopment of a zone of retinal thickening one disc diameter or larger size,Classification- 1. Focal exudative maculopathy2. Diffuse exudative maculopathy3. Ischemic maculopathy4. Mixed
Slide104. Advanced diabetic eye diseaseIt is an end result of un controlled PDR.Marked by complications like: Persistent vitreous haemorrhageTractional retinal detachmentNeovascular glaucoma
Slide11Signs & symptoms of DRBlurred or distorted vision or difficulty readingFloatersPartial or total loss of visionA shadow or veil across patient’s visual fieldEye pain
Slide12Slide13Slide14Slide15InvestigationsUrine examinationBlood sugar examinationFundus fluorescein angiography
Slide16treatment1. Screening and follow up for diabetic retinopathy:No diabetic retinopathy or early NPDR - Every yearModerate NPDR - Every 6 monthsSevere NPDR - Every 3 monthsPDR with no risk characterstics - Every 2 months
Slide172. Medical therapy1. Prevention: Control of risk factors: Control blood sugar – HbA1c < 7Control blood pressure – SBP < 130 mmHgControl lipid profile – TG, LDLCorrect anemiaControl diabetic nephropathyPregnancy makes DR worsen
Slide182. Role of pharmacological modulation: Protein kinase c inhibitorsVascular indothelial growth factors inhibitors Aldose reductase and ACE inhibitorsAntioxidants like vitamin E3. Intravitreal steroids - Reduces diabetic macular oedema
Slide193. PHotocoagulation1. Macular photocoagulation- (macular oedema)Focal treatment – Microaneurysm OR Leaking vessels (Whiten microaneurysm)Grid treatment – to achieve mild burn (C shape manner)2. Panretinal photocoagulation (PRP)- laser burns are applied 2-3 disc area from the center of macula to prevent recurrent vitreous haemorrhage Neovascular iris Severe NPDR with one eye pt, pregnancy, renal failurePDR with HRC
Slide204. Surgical treatmentIn advanced cases with PDRParse plana vitrectomy –Vitreous haemorrhageTractional retinal detachment
Slide21Thank you