diabetic disease[1]
TRANSCRIPT
Diabetic eye disease
Dr Ho Sze Yuen
FHKAM (Ophthalmology)
Important facts
Risk of blindness is 25 times greater in diabetic than is non-diabetics
The incidence of DR is related more to the duration of diabetes than to any other factor.
In patients diagnosed as diabetic prior to the age to 30 years,
50% DR after 10 years
90% DR after 30 years
Background diabetic retinopathy
Pathogenesis
Microangiopathy affecting the arterioles, capillaries, venules
Microvascular occlusion and leakage.
Pathology of microvascular leakage breakdown of basement membrane of
capillaries
Consequences of microvascular leakage Increased vascular permeability Retinal heamorrhage and oedema
Circinate ring
Circinate ring laser
Pathology of microvascular occlsuion Ischeamia of retina Stimulate aniogenic factor Proliferation of new vessels Bleed from new vessels
Consequences of microvascular occlusion Microvascular occlusion hyopoxic retina vasoformative substnace Neovascularization
Proliferative diabetic retinopathy
Preliferatibe diabetic retinopathy
Proliferative diabetic retinopathy
Proliferative diabetic retinopathy
Pre-retinal haemorrhage
Recommendation
Annual check of retina, either by GP or ophthalmologist
When to refer
When you see pathology, not to wait until vision drops
Vision is normal in background diabetic retinopathy, until macular edema
Vision is normal in proliferative diabetic retinopathy, with new vessels until vitreous haemorrhage
Fluorescein angiography procedure
Fluorescein angiogram
Fluorescein angiogram
Pan-retinal phtocoagulation(PRP)
Laser application
Proliferative diabetic retinopathy after PRP
Tractional retinal detachment
Advanced tractional retinal detachment
Indications for laser
Macular edema Proliferative diabetic retinopathy
Circinate ring
Circinate ring laser
Effects of macular laser seal off the leaking vessels, Prevent further leakage, The existing edema needs 2-3 months to be
absorbed Since scars are induced by laser, the vision may
drop a little bit after laser, The result may sacrifice some vision, to attain a
stable vision in future
Effects of laser for new vessels,pan-retinal photocoagulation (PRP) To ablate the peripheral normal retina, and
save the central part Aim is to decrease the nutrient demand, the
residual nutrient can concentrate to the central retina
Patient may feel dim or blur of peripheral field
Pan-retinal phtocoagulation(PRP)
Conclusion
Diabetic retinopathy is more likely in patients with long history of DM, or poor control
Diabetic retinopathy is generally a downhill disease
Laser is the only treatment to decrease the rate of deterioration or stabilize the condition
Conclusion
If vitreous heamorrhage occurs, laser cannot penetrate the haemorrhage and aim on the retinal pathology, the surgery is indicated to aspirate the haemorrhage
To prevent complication is better than to treat
To treat early is better than to treat late