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| {{Diabetic retinopathy}} | | {{Diabetic retinopathy}} |
| {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] | | {{CMG}}; {{AE}} {{RBS}} [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; [[Afsaneh Morteza|Afsaneh Morteza, MD-MPH]] [mailto:afsaneh.morteza@gmail.com] |
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| == [[Diabetic retinopathy overview|Overview]] == | | ==[[Diabetic retinopathy overview|Overview]]== |
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| == [[Diabetic retinopathy historical perspective|Historical Perspective]] == | | ==[[Diabetic retinopathy historical perspective|Historical Perspective]]== |
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| == [[Diabetic retinopathy classification|Classification]]== | | ==[[Diabetic retinopathy classification|Classification]]== |
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| ==[[Diabetic retinopathy pathophysiology|Pathophysiology]] == | | ==[[Diabetic retinopathy pathophysiology|Pathophysiology]]== |
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| ==[[Diabetic retinopathy differential diagnosis|Differentiating Diabetic retinopathy from other diseases]]== | | ==[[Differentiating Diabetic retinopathy from other diseases|Differentiating Diabetic retinopathy from other Diseases]]== |
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| ==[[Diabetic retinopathy epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Diabetic retinopathy epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Diabetic retinopathy risk factors|Risk Factors]]== | | ==[[Diabetic retinopathy risk factors|Risk Factors]]== |
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| ==[[Diabetic retinopathy screening|Screening]]== | | ==[[Diabetic retinopathy screening|Screening]]== |
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| ==[[Diabetic retinopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Diabetic retinopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==History and Symptoms== | | ==Diagnosis== |
| | | [[Diabetic retinopathy history and symptoms|History and Symptoms]] | [[Diabetic retinopathy physical examination|Physical Examination]] | [[Diabetic retinopathy laboratory findings|Laboratory Findings]] | [[Diabetic retinopathy electrocardiogram|Electrocardiogram]] | [[Hashiomoto's thyroiditis chest x ray|Chest X Ray]] | [[Diabetic retinopathy CT|CT]] | [[Diabetic retinopathy MRI|MRI]] | [[Diabetic retinopathy echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Diabetic retinopathy other imaging findings|Other Imaging Findings]] | [[Diabetic retinopathy other diagnostic studies|Other Diagnostic Studies]] |
| * When the disease first starts, there are no symptoms.
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| * [[Blurred vision]] and slow vision loss over time
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| * Eye floaters and spots
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| * Shadows or missing areas of vision
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| * Trouble seeing at night
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| * Fluctuating vision
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| * Blurry and/or distorted vision
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| * [[Double vision]]
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| * Other symptoms are related to diabetic ocular disease
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| After the [[hemorrhage]] due to PDR, most of the symptoms occurs. The first time, it may not be very severe.
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| In most cases, it will leave just a few specks of [[blood]], or spots, floating in a person's visual field, though the spots often go away after a few hours.These spots are often followed within a few days or weeks by a much greater leakage of blood, which blurs vision. In extreme cases, a person will only be able to recognize the light.
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| <gallery>
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| Image:Human eyesight two children and ball normal vision.jpg|Normal vision. Courtesy [[National Institutes of Health|NIH]] [[National Eye Institute]]
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| Image:Human eyesight two children and ball with diabetic retinopathy.jpg|The same view with diabetic retinopathy.
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| </gallery>
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| == Physical Examination ==
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| * History taking is the first step.
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| * Blood pressure measurement,
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| * [[BMI]] calculation
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| * Monitoring fasting [[blood sugar]]
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| * Measuring HbA1c,
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| * The history of any visual symptoms and changes in the vision
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| * Visual acuity test
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| * Fundoscopic examination using ophthalmoscopy or slit lamp bio-microscopy
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| The personnel performing the examination require considerable training accreditation.
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| On [[fundoscope|fundoscopic]] the physician is looking for [[cotton wool spots]], [[flame hemorrhages]], [[dot-blot hemorrhages]] and [[boat hemorrhages]].
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| ===Cotton Wool Spots===
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| [[Image:Proliferative retinopathy.JPG|thumb|left|An ophthalmoscopic view of the retina showing advanced signs of diabetic retinopathy including two pale cotton wool spots.]]
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| [[Cotton wool spots]] are an abnormal finding on [[fundoscope|fundoscopic]] exam of the [[retina]]. They appear as puffy white patches on the [[retina]]. They are caused by damage to nerve fibers. The nerve fibers are damaged by swelling in the surface layer of the retina. The cause of this swelling is due to the reduced [[axonal]] transport (and hence backlog of intracellular products) within the nerves because of the ischemia.{{clr}} | |
| ===Flame Hemorrhages===
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| [[Image:Flame-hemorrhage.jpg|thumb|left|A dark red flame hemorrhage in the retina of a diabetic is shown at the arrow: Credit: University of Michigan Kellogg Eye Center]] [[Flame hemorrhages]] are flame shaped hemorrhages located in the superficial nerve fiber layer of the retina that appear dark dark red on fundoscopic examination. Flame hemorrhages are caused by leakage from arterioles due to ischemic damage or from veins that are ischemic or in under high pressure.{{clr}}
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| ===Dot Hemorrhages===
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| [[image:Dot-hemorrhage.jpg|thumb|left|White arrow points to a dot hemorrhage in a dibetic patient. Credit: University of Michigan Kellogg Eye Center]]
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| [[Dot hemorrhages]] are dark red round spots of hemorrhage seen on fundoscopic exam. They are frequently observed in patients with diabetic retinopathy. Dot hemorrhages are due to either capillary or venular leak. The site of hemorrhage is deep within the retina. {{clr}} | |
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| ===Boat Hemorrhages===
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| [[Image:Boat-hemorrhage.jpg|left|thumb|White arrow points to a boat hemorrhage in a dibetic patient. Credit: University of Michigan Kellogg Eye Center]]
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| [[Boat hemorrhages]] are rectangular dark red spots of hemorrhage seen on fundoscopic exam. They are frequently observed in patients with diabetic retinopathy. Boat hemorrhages are due to either [[capillary]] or venular leak. The site of hemorrhage is at the interface between the [[retina]] and the [[vitreous humor]]. The contents that leak out are under such high-pressure that they break through the internal membrane of the [[retina]]. | |
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| ==Treatment== | | ==Treatment== |
| People with advanced retinopathy have a 90 percent chance to retain their vision when they get treatment before the retina is severely damaged. Besides of the tight diabetic management, there are three major treatments for diabetic retinopathy.
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| * [[Laser surgery]]
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| * [[Triamcinolone]] injection to the eye
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| * [[vitrectomy]]
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| Caution should be exercised in treatment with laser surgery since it causes a loss of retinal tissue. It is often more prudent to inject triamcinolone. In some patients it results in a marked increase of vision, especially if there is an edema of the macula.
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| Avoiding tobacco use and correction of associated [[hypertension]] are important therapeutic measures in the management of diabetic retinopathy. <ref name=AMN>{{cite web | Umesh Masharani, MB, BS, MRCP | title =Diabetes Ocular complications | publisher=Armenian Medical Network | work =Chronic Complications of Diabetes | url=http://www.health.am/db/diabetes-ocular-complications/ | year = 2006 }}</ref>
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| === Laser surgery ===
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| A type of laser surgery called ''panretinal photocoagulation'', or PRP, is used to treat severe [[macular edema]] and PDR. The goal is to create 1 000 - 2 000 burns in the retina to reduce retina's oxygen demand, and hence the possibility of ischemia. In treating advanced diabetic retinopathy, the burns are used to destroy the abnormal blood vessels that form at the back of the eye.
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| Rather than focus the light on a single spot, the eye care professional may make hundreds of small laser burns away from the center of the retina, a procedure called ''scatter laser treatment'' or ''panretinal photocoagulation''.The treatment shrinks the abnormal blood vessels.
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| Patients may lose some of their peripheral vision after this surgery, but the procedure saves the rest of the patient's sight.
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| Laser surgery may also slightly reduce color and night vision.
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| === Vitrectomy ===
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| A [[vitrectomy]] is performed when there is a lot of blood in the [[vitreous humour|vitreous]].
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| It involves removing the cloudy vitreous and replacing it with a saline solution made up of [[salt]] and [[water]].
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| Because the vitreous is mostly water, there should be no change between the saline solution and the normal vitreous. Studies show that people who have a vitrectomy soon after a large hemorrhage are more likely to protect their vision than someone who waits to have the operation.
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| ==References==
| | [[Diabetic retinopathy medical therapy|Medical Therapy]] | [[Diabetic retinopathy surgery|Surgery]] | [[Diabetic retinopathy primary prevention|Primary Prevention]] | [[Diabetic retinopathy secondary prevention|Secondary Prevention]] | [[Diabetic retinopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Diabetic retinopathy future or investigational therapies|Future or Investigational Therapies]] |
| {{reflist|2}}
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| {{WikiDoc Help Menu}}
| | ==Case Studies== |
| {{WikiDoc Sources}}
| | [[Diabetic retinopathy case study one|Case #1]] |
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| [[Category:Disease]] | |
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| ==Related chapters== | | ==Related chapters== |
| *[[List of terms associated with diabetes]] | | *[[List of terms associated with diabetes]] |
| ==External links== | | *[[Diabetic neuropathy]] |
| | *[[Diabetes]] |
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| | ==External Links== |
| *[http://www.nei.nih.gov/health/diabetic/retinopathy.asp Diabetic Retinopathy] Resource Guide from the National Eye Institute (NEI). | | *[http://www.nei.nih.gov/health/diabetic/retinopathy.asp Diabetic Retinopathy] Resource Guide from the National Eye Institute (NEI). |
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| [[Category:Ophthalmology]] | | [[Category:Ophthalmology]] |
| [[Category:Diabetes]] | | [[Category:Pediatrics]] |
| [[Category:Blindness]]
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
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