1、Diabetic RETINOPATHY,Prof. Raj Vardhan Azad,Diabetes: Global Perspective,Diabetes Challenges,Total no of people with diabetes is projected to rise 171 million 2000 to 366 million in 2030DR is the 3rd leading cause of visual impairment among inner city Adults 40 yrs of age.,Biochemical mechanismsCapi
2、llaropathy Haematological changes Microvascular occlusion,PATHOGENESIS DR糖尿病视网膜病的发病机理,ANGIOGENIC FACTORS,组织缺氧,血管内皮细胞生长因子数量上升,视网膜屏障与新生血管形成,CLINICAL FEATURES临床特征,Microaneurysms 微动脉瘤Hemorrhages 眼底出血Soft Exudates 血管软性渗出Venous Caliber Alterations 静脉管径改变Intraretinal Microvascular abnormalites 视网膜微血管异常New
3、Vessels 新生血管的出现Macular Edema 黄斑水肿,Microaneurysms微动脉瘤的形成,山梨糖醇与游离基的聚集,外膜细胞受到破坏,微动脉瘤形成,Hemorrhages眼底出血的形成,Dot and BlotThey occur in deeper capillary plexus and spread antero-posteriorly like a cylinder,New Vessels,Budding endothelial tubules from venous end of the capillary bed NVE Neovascularisation e
4、lsewhereNVD Neovascularisation of the disc,Macular Edema,Focal,Diffuse,ETDRS Classification,NPDRMildModerateSevereVery SeverePDRWithout HRCWith HRCAdvancedMacular EdemaCSME,MicroaneurysmsMild to moderate Intra-retinal haemorrhages in 4 quadsHard exudatesMacular oedema Foveal avascular zone abnormali
5、ties,Cotton-wool spotsIntraretinal haemorrhages in 4 quadrantVenous beading IRMA,Severe intraretinal hemorrhages in 4 quadrantsVenous beading in 2 quadrantsModerately severe IRMA in 1 quadrant“4-2-1 Rule”Severe NPDR: Any 1 of the aboveVery Severe NPDR: Any 2 of the above,NVDNVEPreretinal hemorrhages
6、 Vitreous hemorrhagesTractional retinal detachmentNVI / NVA /or both,NVD atleast -1/3 disc area in extentNVD with preretinal or vitreous hemorrhageNVE atleast disc areas in extent & associated with pre- retinal or vitreous hemorrhage.,Investigations,Visual Acuity and Refraction Slit Lamp Slit Lamp B
7、iomicroscopy with +90D lens Indirect Ophthalmoscopy Fundus Flourescein Angiography(FFA) Optical Coherence Tomography,FFA in DR,Always on first visitClinical SuspicionConfirm and documentType/ Location etcTreatmentAnd on Follow-up:For activityTo confirm resolutionDisease worsening/ complications,FFA
8、in DR,No DR,Diffuse Diabetic Macular Edema,FFA in DR,Ischemic ME,NVE suspicion in IRMA,OCT Types,SPONGY,THICK HYALOID,CYSTOID,VMT,Current treatment approach,Medical treatment Tight control of blood sugar/ blood pressureControlling hyperlipidaemia/ renal status/ anaemiaLaser treatment Conventional la
9、ser Laser indirect ophthalmoscope delivery Pascal,Intravitreal injections Intravitreal steroid injection Posterior sub-tenon steroid injectionIntravitreal anti-VEGF agentsSurgical intervention Intravitreal steroid implantsPars plana vitreous surgery,Surgical Approach,Posterior Hyaloid Separation,Complete,Partial,Significant separation,Narrow separation,Segmentation using vertical scissors,Create separation usingBent MVR,Identify vascular epicentres,Diathermy and delaminate using horizontal/ curved scissors,Thank you,
