Diabetic retinopathy: Difference between revisions
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'''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | ||
{{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}}; '''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] | ||
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== [[Diabetic retinopathy historical perspective|Historical Perspective]] == | == [[Diabetic retinopathy historical perspective|Historical Perspective]] == | ||
== [[Diabetic retinopathy classification|Classification]]== | |||
==[[Diabetic retinopathy pathophysiology|Pathophysiology]] == | ==[[Diabetic retinopathy pathophysiology|Pathophysiology]] == | ||
==[[Diabetic retinopathy differential diagnosis|Differentiating Diabetic retinopathy from other diseases]]== | |||
== Epidemiology and Demographics == | ==[[Diabetic retinopathy epidemiology and demographics|Epidemiology and Demographics]]== | ||
=== Genetics === | === Genetics === | ||
Revision as of 21:09, 14 December 2012
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Diabetic retinopathy Microchapters |
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Treatment |
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Diabetic retinopathy On the Web |
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American Roentgen Ray Society Images of Diabetic retinopathy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Afsaneh Morteza, MD-MPH [4]
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Diabetic retinopathy from other diseases
Epidemiology and Demographics
Genetics
There are evidence that not every diabetic patients has the same risk of diabetic retinopathy. Studies have shown that polymorphisms of Tumor Necrosis Factor Alpha play an important role in the risk of patients with diabetic retinopathy.[1]
Risk Factors
All patients with diabetes mellitus are at risk of developing diabetic retinopathy. This includes those with Type I diabetes and those with Type II diabetes. During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. It is recommended that all pregnant women with diabetes have dilated eye examinations each trimester to protect their vision.
Screening
All patients with type 2 diabetes should be visited by an ophthalmologist prior to diabetes diagnosis.
History and Symptoms
- When the disease first starts, there are no symptoms.
- Blurred vision and slow vision loss over time
- Eye floaters and spots
- Shadows or missing areas of vision
- Trouble seeing at night
- Fluctuating vision
- Blurry and/or distorted vision
- Other symptoms are related to diabetic ocular disease
After the hemorrhage due to PDR, most of the symptoms occurs. The first time, it may not be very severe. 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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Normal vision. Courtesy NIH National Eye Institute -
The same view with diabetic retinopathy.
Physical Examination
- History taking is the first step.
- Blood pressure measurement,
- BMI calculation
- Monitoring fasting blood sugar
- Measuring HbA1c,
- The history of any visual symptoms and changes in the vision
- Visual acuity test
- Fundoscopic examination using ophthalmoscopy or slit lamp bio-microscopy
The personnel performing the examination require considerable training accreditation. On fundoscopic the physician is looking for cotton wool spots, flame hemorrhages, dot-blot hemorrhages and boat hemorrhages.
Cotton Wool Spots
Cotton wool spots are an abnormal finding on 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.
Flame Hemorrhages
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.
Dot Hemorrhages
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.
Boat Hemorrhages
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.
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.
- Laser surgery
- Triamcinolone injection to the eye
- vitrectomy
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. Avoiding tobacco use and correction of associated hypertension are important therapeutic measures in the management of diabetic retinopathy. [2]
Laser surgery
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. 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. Patients may lose some of their peripheral vision after this surgery, but the procedure saves the rest of the patient's sight. Laser surgery may also slightly reduce color and night vision.
Vitrectomy
A vitrectomy is performed when there is a lot of blood in the vitreous. It involves removing the cloudy vitreous and replacing it with a saline solution made up of salt and water. 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.
References
- ↑ Paine SK, Sen A, Choudhuri S, Mondal LK, Chowdhury IH, Basu A; et al. (2012). "Association of tumor necrosis factor α, interleukin 6, and interleukin 10 promoter polymorphism with proliferative diabetic retinopathy in type 2 diabetic subjects". Retina. 32 (6): 1197–203. doi:10.1097/IAE.0b013e31822f55f3. PMID 22105495.
- ↑ "Diabetes Ocular complications". Chronic Complications of Diabetes. Armenian Medical Network. 2006. Text " Umesh Masharani, MB, BS, MRCP " ignored (help)
Related chapters
External links
- Diabetic Retinopathy Resource Guide from the National Eye Institute (NEI).
cs:Diabetická retinopatie de:Diabetische Retinopathie nl:Diabetische retinopathie fi:Diabeettinen retinopatia