Eyes: Diabetic Retinopathy

Eyes: Diabetic Retinopathy 2018-01-30T16:36:19+08:00

Clinical features

  • Non-proliferative diabetic retinopathy (NPDR)
    • No neovascularization
    • Mild
      • ≥ 1 microaneurysms
    • Moderate
      • Soft exudates (cotton wool spots) – nerve fibre layer infarction
      • Hard exudates – lipid deposition
      • Haemorrhages (dot or blot)
      • Venous beading
    • Severe
      • Venous beading in at least two quadrants
  • Proliferative diabetic retinopathy (PDR)
    • Neovascularization from the disc or retinal vessels
    • May arise in the absence of NPDR
    • Early
      • New vessels
    • High-risk
      • Macula involved
    • Complications
      • Vitreous haemorrhage
      • Retinal detachment
  • Macula oedema
    • May occur at any stage of DR
    • Retinal thickening
    • Seen with fluorescein angiography
  • DR is usually asymptomatic until very late
    • Usually not reversible by symptomatic stage
    • Require regular screening

Exacerbating factors

  • Pregnancy
  • Poor glycaemic control
  • Hypertension
  • Diabetic nephropathy
  • Thigh glycaemic control in patients with previously poor glycaemic control

Ocular manifestations of diabetes

  • Central retinal artery occlusion
  • Central retinal vein occlusion
  • Mononeuritis multiplex
  • Vitreous haemorrhage
  • Retinal detachment
  • Cataracts

 Indications for urgent referral (within 2 weeks)

  • Proliferative diabetic retinopathy
  • Macular involvement
  • CRAO / CRVO
  • Retinal detachment
  • Vitreous haemorrhage

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