The document describes the grading of nonproliferative and proliferative diabetic retinopathy (DR) based on the presence of lesions. Nonproliferative DR is graded as mild, moderate, severe, or very severe based on the presence of microaneurysms, hemorrhages, cotton wool spots, and intraretinal microvascular abnormalities. Proliferative DR is categorized as either without or with high risk characteristics and is defined by the presence of new vessels or fibrous proliferations with or without vitreous or preretinal hemorrhage. Advanced proliferative DR involves extensive vitreous hemorrhage, retinal detachment, or enucleation due to DR complications.
The document describes the grading of nonproliferative and proliferative diabetic retinopathy (DR) based on the presence of lesions. Nonproliferative DR is graded as mild, moderate, severe, or very severe based on the presence of microaneurysms, hemorrhages, cotton wool spots, and intraretinal microvascular abnormalities. Proliferative DR is categorized as either without or with high risk characteristics and is defined by the presence of new vessels or fibrous proliferations with or without vitreous or preretinal hemorrhage. Advanced proliferative DR involves extensive vitreous hemorrhage, retinal detachment, or enucleation due to DR complications.
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The document describes the grading of nonproliferative and proliferative diabetic retinopathy (DR) based on the presence of lesions. Nonproliferative DR is graded as mild, moderate, severe, or very severe based on the presence of microaneurysms, hemorrhages, cotton wool spots, and intraretinal microvascular abnormalities. Proliferative DR is categorized as either without or with high risk characteristics and is defined by the presence of new vessels or fibrous proliferations with or without vitreous or preretinal hemorrhage. Advanced proliferative DR involves extensive vitreous hemorrhage, retinal detachment, or enucleation due to DR complications.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
Microaneurysms only No lesions other than microaneurysms
Mild NPDR Microaneurysms plus retinal
hemorrhage, hard exudate Moderate NPDR Mild NPDR plus cotton wool spots and/or IRMA
Severe NPDR Presence of one of the following features:
-Microaneurysms plus venous
beading and/ or H -Standard photo 2A in 4 quadarents, or marked venous beading in 2 or more quadrants or moderate IRMA (standard photo 8A in one or more quadrants)
Very severe NPDR Two or more of the above features described in
severe NPDR Proliferative DR PDR without High Risk New Vessels and/or fibrous Charactristics proliferations; or preretinal and/or vitreous hemorrhage PDR with HRC NVD Standard photo 10A; or less extensive NVD, if vitreous or preretinal hemorrhage is present; NVE equal to or more than half disc area, if vitreous or preretinal hemorrhage is present
Advanced PDR Extensive vitreous hemorrhage
precluding grading, retinal detachment involving the macula, or pthisis bulbi or enucleation secondary to a complication of DR Microaneurysms
Earliest clinical sign of diabetic retinopathy
Secondary to capillary wall outpouching due to pericyte loss Appear as small red dots in the superficial retinal layers Rupture produces blot/flame hemorrhages Dot and blot hemorrhages
Occur as microaneurysms rupture in the deeper layers
of the retina such as the inner nuclear and outer plexiform layers Appear similar to microaneurysms if they are small; may need fluorescein angiography to distinguish between the two Flame-shaped hemorrhages
Splinter hemorrhages that occur in the more
superficial nerve fiber layer Retinal edema and hard exudates
Caused by the breakdown of the blood-retina barrier,
allowing leakage of serum proteins, lipids, and protein from the vessels Cotton-wool spots
Nerve fiber layer infarction from occlusion of
precapillary arterioles Fluorescein angiography - No capillary perfusion Frequently bordered by microaneurysms and vascular hyperpermeability Venous loops, venous beading
Frequently adjacent to areas of nonperfusion
Reflects increasing retinal ischemia Most significant predictor of progression to PDR Intraretinal microvascular abnormalities
Remodeled capillary beds without proliferative
changes Collateral vessels that do not leak on fluorescein angiography Usually can be found on the borders of the nonperfused retina Macular edema Possibly due to functional damage and necrosis of retinal capillaries Clinically significant macular edema (CSME) is defined as any of the following: Retinal thickening located 500 micron or less from the center of the foveal avascular zone (FAZ) Hard exudates with retinal thickening 500 micron or less from the center of the FAZ Retinal thickening 1 disc area or larger in size located within 1 disc diameter of the FAZ Neovascularization
Hallmark of PDR Most often occurs near the optic disc (neovascularization of the disc [NVD]) or elsewhere (neovascularization elsewhere [NVE]) Preretinal or vitreous hemorrhage
Preretinal hemorrhages appear as pockets of blood
within the potential space between the retina and the posterior hyaloid face. As the blood pools within this space, they may appear boat shaped. Hemorrhage into the vitreous may appear as a diffuse haze or as clumps of blood clots within the gel. Fibrovascular tissue proliferation is usually seen associated with the neovascular complex and also may appear avascular when the vessels have already regressed. Traction retinal detachments usually appear tented up, immobile, and concave compared to rhegmatogenous retinal detachments, which are bullous, mobile, and convex. However, a combination of both mechanisms is not an uncommon finding. Macular edema
Leading cause of visual impairment in patients with diabetes
Possibly due to functional damage and necrosis of retinal capillaries In cases of PDR, edema also may be caused by retinal traction if the retina is sufficiently elevated away from the retinal pigment epithelium (RPE). CSME is defined as any of the following: Retinal thickening located 500 microns or less from the center of the foveal avascular zone (FAZ) Hard exudates with retinal thickening 500 microns or less from the center of the FAZ Retinal thickening 1 disc area or larger in size located within 1 disc diameter of the FAZ Grading Severity of Retinopathy in Research