糖尿病視網(wǎng)膜病(全英)

1、Prof. Raj Vardhan AzadDiabetes: Global PerspectiveDiabetes ChallengesTotal no of people with diabetes is projected to rise 171 million 2000 to 366 million in 2030DR is the 3rd leading cause of visual impairment among inner city Adults 40 yrs of age.Biochemical mechanismsCapillaropathy Haematological

2、 changes Microvascular occlusion PATHOGENESIS DR糖尿病視網(wǎng)膜病的發(fā)病機理糖尿病視網(wǎng)膜病的發(fā)病機理ANGIOGENIC FACTORSHypoxiaVEGFBRB breakdown And new vessel formation組織缺氧血管內(nèi)皮細胞生長因子數(shù)量上升視網(wǎng)膜屏障與新生血管形成CLINICAL FEATURES臨床特征Microaneurysms 微動脈瘤微動脈瘤Hemorrhages 眼底出血眼底出血Soft Exudates 血管軟性滲出血管軟性滲出Venous Caliber Alterations 靜靜脈管徑改變脈管徑改變In

3、traretinal Microvascular abnormalites 視網(wǎng)膜微血管異常視網(wǎng)膜微血管異常New Vessels 新生血管的出現(xiàn)新生血管的出現(xiàn)Macular Edema 黃斑水腫黃斑水腫Microaneurysms微動脈瘤的形成Sorbitol And Free Radical AccumulationDestruction Of PericytesMicroaneurysm山梨糖醇與游離基的聚集外膜細胞受到破壞微動脈瘤形成Hemorrhages眼底出血的形成Dot and BlotThey occur in deeper capillary plexus and sprea

4、d antero-posteriorly like a cylinder New VesselsBudding endothelial tubules from venous end of the capillary bed NVE Neovascularisation elsewhereNVD Neovascularisation of the discMacular EdemaFocalDiffuseETDRS ClassificationNPDRMildModerateSevereVery SeverePDRWithout HRCWith HRCAdvancedMacular Edema

5、CSMEMicroaneurysmsMild to moderate Intra-retinal haemorrhages in 4 quadsHard exudatesMacular oedema Foveal avascular zone abnormalitiesCotton-wool spotsIntraretinal haemorrhages in 4 quadrantVenous beading IRMASevere intraretinal hemorrhages in 4 quadrantsVenous beading in 2 quadrantsModerately seve

6、re IRMA in 1 quadrant“4-2-1 Rule”Severe NPDR: Any 1 of the aboveVery Severe NPDR: Any 2 of the aboveNVDNVEPreretinal hemorrhages Vitreous hemorrhagesTractional retinal detachmentNVI / NVA /or bothNVD atleast -1/3 disc area in extentNVD with preretinal or vitreous hemorrhageNVE atleast disc areas in

7、extent & associated with pre- retinal or vitreous hemorrhage.InvestigationsVisual Acuity and Refraction Slit Lamp Slit Lamp Biomicroscopy with +90D lens Indirect Ophthalmoscopy Fundus Flourescein Angiography(FFA) Optical Coherence Tomography FFA in DRAlways on first visitClinical SuspicionConfir

8、m and documentType/ Location etcTreatmentAnd on Follow-up:For activityTo confirm resolutionDisease worsening/ complicationsFFA in DRNo DRDiffuse Diabetic Macular EdemaFFA in DRIschemic MENVE suspicion in IRMAOCT Types SPONGYTHICK HYALOIDCYSTOIDVMTCurrent treatment approachMedical treatment Tight con

9、trol of blood sugar/ blood pressureControlling hyperlipidaemia/ renal status/ anaemiaLaser treatment Conventional laser Laser indirect ophthalmoscope delivery PascalIntravitreal injections Intravitreal steroid injection Posterior sub-tenon steroid injectionIntravitreal anti-VEGF agentsSurgical inter

10、vention Intravitreal steroid implantsPars plana vitreous surgery Current Treatment ProtocolSystemic ControlScreeningNon Proliferative Diabetic RetinopathyFollow-upTreatment consideration for severe NPDR especially with other risk factors with PRPMacular OedemaIdentify CSMEFFA/ OCT(R/O Ischemia)Laser(Focal/ Grid)Pharmacological(Steroid/ AntiVEGF)Proliferative Diabetic RetinopathyIdentify HRCLaser (Pan retinal photocoagulation)Identify indications for SurgeryPars Plana VitrectomySurgical ApproachPosterior Hyaloid SeparationCompletePartialSignificant separatio