RETINOPATHY

DIABETIK
Fundus normal
Papil normal
 DIABETIC RETINOPATHY

Frequent cause of blindness in USA,

aged 20 to 64 years
Indonesia blindness due to D.R.
increase
PATHOGENESIS

The exact cause is still unclear

It is believed :
 Hiperglycemia over an extended period results in
a number biochemical and physiologic changes ---
endothelial damage.
 Retinal vascular changes : loss of pericyte
basement membrane thickening---compromises
capillary lumen--- decompensation of endothelial
barrier function
 Hematologic and biochemical
abnormalities
Increased platelet adhesiveness
Increaser erythrocyte aggregation
Abnormal serum lipids
Defective fibrinolysis
Abnormal levels of growth hormone : ex
vascular endothelial growth factor (VEGF)
Abnormalities in serum and whole blood
viscosity
ADVANCED DIABETIC RETINOPATHY

Risk factor for :

 Cardiovascular disease
 Heart attack

 Stroke

 Diabetic nephropathy

 Amputatia

 Death
CLASSIFICATION
Non proliferative diabetic retinopathy (NPDR) =
back ground diabetic retinopathy :
 Mild
 Moderate
 Severe
 Very severe
Proliferative Diabetic Retinopathy :
 Early
 High risk
 Advanced
Macular edema
NPDR : Retinal microvasculer changes
limited to the retina
 Micro aneurysme
 Dot & blot hemorrhage
 Retinal edema
 Hard exudates
 Dilatation & bleading of the vein
 Intraretinal micro vascular abnormalites (IRMA)
 Nerve fiber layer infarct (cotton wool spot)
 Areas of capillary non perfussion
RH :
RD tahap awal
RD : mikroaneurisma + hard exudate
Gamb. fluoresin
RD 1: cotton wool + Flame shaped
RD 2
RD 2 (fluoresin)
Affect visual function through
 Capillary disease ischemic
 Vascular permeability edema
Diabetic macular edema
 The most common :
 Cause of VA
 Cause focal

 Cause diffuse
Proliferative diabetic retinopathy (PDR)
Extra retinal fibrovascular proliferation
extends beyond the ILM
RD proliferatif
 NPDR

Ischemic retina

Release of vaso poliferative factors

Neovascularization of the retina

optic neuro head, ant.signal
RD proliferatif
 COMPLICATION

Reduced of visual acuity

Vitreous hemorrhage
Traction retinal detachment
Neurovascular glaucoma
RD prolif.+ ablasio
 TREATMENT

Regulation of blood glucose level

Laser photocoagulation
Vitrectomy
RD prolif + tx laser