Diabetic Retinopathy

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

Diabetic Retinopathy risk factors include

  • Poor blood glucose control
  • Protein in urine
  • High blood pressure
  • Prolonged diabetes
  • Raised fats (triglycerides) in the blood

Signs And Symptoms Of Diabetic Retinopathy May Include

  • Blurred vision
  • The impairment of color vision
  • Floaters, or transparent and colorless spots and dark strings that float in the patient’s field of vision
  • Patches or streaks that block the person’s vision
  • Poor night vision
  • Sudden and total loss of vision

Diabetic Retinopathy Is Classified Into

  • BACKGROUND DIABETIC RETINOPATHY (BDR)
  • NON PROLIFERATIVE DIABETIC RETINOPATHY (NPDR)
  • PROLIFERATIVE DIABETIC RETINOPATHY (PDR)

Background Retinopathy

Is an early stage of retinal damage when small blood vessels in the retina show signs of damage that can result from diabetes. As retinal arteries does not receive proper oxygen, ischemia develops because of which there will be outpouching of arteries.

Mild Nonproliferative Retinopathy

Small areas of balloon-like swelling in the retina’s tiny blood vessels, called microaneurysms, occur at this earliest stage of the disease. These microaneurysms may leak fluid into the retina. TREATMENT IS GIVEN TO PREVENT THE FURTHER CHANGES IN RETINA AND TO AVOID PROGRESSION OF DISEASE FROM MILD NPDR TO MODERATE NPDR BY IMPROVING THE RETINAL STATUS.

MODERATE NPDR

More than just microaneurysms but less severe NPDR.

Moderate Nonproliferative Retinopathy

As the disease progresses, blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood. Both conditions cause characteristic changes to the appearance of the retina and may contribute to DME.

SEVERE NPDR

Many more blood vessels are blocked, depriving blood supply to areas of the retina. These areas secrete growth factors that signal the retina to grow new blood vessels.

Any of the following (4-2-1 rule) and no signs of proliferative retinopathy:

  • Severe intraretinal hemorrhages and microaneurysms in each of four quadrants
  • Definite venous beading in 2 or more quadrants
  • Prominent IRMA in 1 or more quadrants

International Classification

Any of the following and no signs of PDR
  • More than 20 intraretinal hemorrhages in each of four quadrants
  • Definite venous beading in two or more quadrants
  • Prominent IRMA in one or more quadrants

PROLIFERATIVE DIABETIC RETINOPATHY

Proliferative diabetic retinopathy (PDR) is the more advanced form of the disease. At this stage, circulation problems deprive the retina of oxygen. As a result new, fragile blood vessels can begin to grow in the retina and into the vitreous, the gel-like fluid that fills the back of the eye. The new blood vessels may leak blood into the vitreous, clouding vision.

Characterized by growth of new vessels on the surface of the retina.

Signs

Fine to severe loops of new vessels that may grow on the optic disc: neovascularization of the disc (NVD) or elsewhere (NVE)

In the anterior segment, PDR is manifested by neovascularization of the iris (NVI), the angle (NVA) and may eventually complicated with neovascular glaucoma

These new vessels may leak and resulting in retinal edema. They are also fragile and prone to bleed

Opaque fibrovascular proliferation tissue often appears on the internal limiting membrane (adjacent to the new vessels) and becomes adherent to the vitreous

Contraction Of This Fibrovascular Tissue May Lead To

  • Distortion or dragging of the macula
  • Mild to extensive retinal detachment
  • Avulsion of retinal vessels and vitreous hemorrhages.

Risk Factors

One or both of the following:
  • Neovascularization.
  • Vitreous \ preretinal haemorrhage.

PDR WITH TRACTIONAL RETINAL DETACHMENT(TRD)

IN THIS CONDITION OF RETINA OUR TREATMENT HELPS IN STABILITY OF RETINA DEPENDING ON THE TRACTIONS AND WHEN THERE IS NO RETINAL DETACHMENT

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