Diabetic retinopathy
(diagnostics, therapy, classification)
Veronika Matušková
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Diabetes mellitus- definition
•Diabetes mellitus is disease with high glucose level (hyperglycaemia) due to absolute or relative
lack of insulin produced in beta cells of Langerhans pancreatic islets

Diabetes mellitus (late complications)
1.retinopathy
2.nephropathy
3.diabetic foot
4.neuropathy

Diabetic retinopathy (definition)
•Diabetic retinopathy is microangiopathy,
•HbA1c is very important

1.Nonproliferative DR (NPDR)
2.Proliferative DR (PDR)
3.Diabetic maculopathy (M)
•    (each level of diabetic retinopathy may or may not beaccompanied by diabetic maculopathy)
Classification of diabetic retinopathy

Nonproliferative DR (NPDR)
•Beginning
•Intermediate
•Advanced

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Beginning NPDR


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Intermediate NPDR


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Intermediate NPDR


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Advanced NPDR


Proliferative DR (PDR)
•Light
•Intermediate
•Fully advanced  VH- vitreous hemorrhage, PRH- preretinal hemorhage, TRD- tractional retinal
detachment at center of macula

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Light PDR


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Intermediate PDR


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Fully advanced PDR


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Fully advanced PDR


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Vitreous hemorrhage in fully advanced PDR


Fluorescein angiography
•
•
Související obrázek Výsledek obrázku pro fa diabetic

•Macular area is a predilection site for edema formation
•Microangiopathy leads to ischemia, fluid accumulation, formation of microcysts and cysts
•Hard exudates (lipid accumulation) occur on the boundary of ischemic and normal retina
Diabetic maculopathy (M)

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Diabetic makulopathy (M)


Diabetic makulopathy (classification)
•Focal edema
•Difuse edema
•Ischemic edema (rare)- avascular zone in macula
Výsledek obrázku pro oct dme

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Focal edema


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Difuse edema


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Ischemic edema


Macular oedema – laser therapy
1.Focal
2. Grid
3.
•

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Focal laser


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Grid laser


Macular oedema - anti VEGF
1.  DME without reaction to laser therapy
2. Good compensation of DME
3. Lasting of DME < 2 years
•

Therapy of diabetic retinopathy
•Gold standard is laser photocoagulation of ischemic retinal parts – panretinal photocoagulation
•Laser can‘t be performed in central macular zone
Související obrázek

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Laser spots in retina  suffered from NPDR


Surgical therapy of DR
•Pars plana vitrectomy- (Machemer, Parel – 1970) – tractional retinal detachment, haemophtalmus