Diabetic Retinopathy

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Presentation :

Leading cause of preventable blindness among persons with diabetes between ages 20 and 74 years in developed countries

Diabetic retinopathy changes are classified as nonproliferative or proliferative:
- Nonproliferative: findings may include microaneurysms, dot and blot hemorrhages, hard exudates (lipid deposition), soft exudates or cotton-wool spots (ischemic superficial nerve fibers), venous bleeding, and intraretinal microvascular abnormalities.
- Proliferative: characterized by neovascularization 2/2 chronic ischemia which may result in vitreous hemorrhage, retinal detachment, and vision loss
Macular edema causes vision loss and may occur with nonproliferative and proliferative retinopathy

Control of blood glucose and blood pressure (BP)
Macular edema: intraocular injection of anti-VEGF agents (eg, ranibizumab, bevacizumab, aflibercept) and/or focal laser photocoagulation.
- Intraocular corticosteroids can be used to treat persistent macular edemna
High-risk or complicated proliferative retinopathy: anti-VEGF drugs, panretinal laser photocoagulation and sometimes vitrectomy
- High-risk characteristics include: vitreous hemorrhage, extensive preretinal neovascularization, or anterior segment neovascularization/neovascular glaucoma
Anti-VEGF therapy requires monthly injections for at least 12 months followed by intermittent injections to prevent recurrent macular edema.
Vitrectomy can help preserve and often restore lost vision in patients with any of the following:
- Persistent vitreous hemorrhage
- Extensive preretinal membrane formation
- Traction retinal detachment
- Recalcitrant diabetic macular edema