Diabetic

Retinopath
y
UNIT VITREORETINA
 Diabetic Retinopathy
Microvascular complication of DM

Leading cause of vision loss in working adults populations

Poorer quality of life 1 of 3 persons in DM in US, Australia, Europe, and Asia

1 in 10 (10.2%) had vision threatening DR

(VTDR)
PDR DME
 Endothelial blood-vessel
Blood Retinal Barrier
neuron
Control nutrient flow to neural retina

Inner retina Capillary beds Inner Nuclear layers

Autoregulation of retinal vascular blood flow Ganglion cells

Outer retina Photoreceptor neurons Muller cells

Nutrient and oxygen Diffusing Choroidal vessel

Antonetti et al., 2012

D.A. Antonetti, R. Klein, T.W. GardnerDiabetic retinopathy
New England Journal of Medicine, 366 (13) (2012), pp. 1227-1239
Pathogenesis
Hyperglycemia

biochemical and molecular pathway changes

PKC pathway AGEs

Increase
activation accumulation
inflammatory
oxidative stress

Cappilary occlusion

Retinal nonperfusion
Endothelial Damage
and Pericyte loss
The pathology associated with diabetic
retinopathy
JudithLechnerOlivia E.O'LearyAlan
W.Stitt
 Classification of Diabetic Retinopathy
Classic retinal lesion
microaneurysms hemorrhages Venous beading Cotton-wool
spots
Intraretinal microvascular Hard Exudate Retinal neovascularization
abnormalities (lipid deposits)
Classification
Nonproliferative Diabetic Diabetic Macular
Proliferative Diabetic Retinopathy (PDR
Retinopathy (NPDR) Edema (DME)
Nonproliferative Diabetic Retinopathy
(NPDR)
 Proliferative Diabetic Retinopathy (PDR
VEGF
Retinopathy
(Major Proangiogenic
progresses Factor)
Retina Optic Nerve
Head
Anterior
Segment
Capillary Retinal
Damage Retinal
ischemi Neovacularization
a
Nonperfusion
increase
PDR
Extraretinal fibrovascular proliferation

1. Fine new vessel with minimal fibrous tissue cross and extend beyond the ILM

2. The New vessels increase in size and extent, developing an increased fibrous component

3. New vessel regress, leaving residual fibrovascular tissue that may be tethered within the
posterior hyaloid
Diabetic Macular Edema (DME)
No retinopathy
 Microaneurysms

MILD NONPROLIFERATIVE
DIABETIC RETINOPATHY
 Moderate Nonproliferative Diabetic Retinopathy
(NPDR)

Microaneurysm
Characteristics
More than just microaneurysms but less than
severe NPDR

Hard exudates

Flamed shaped
hemorrhage
Moderate Nonproliferative
Diabetic Retinopathy (NPDR)

Hard exudates

microaneurysm
Severe Nonproliferative Diabetic Retinopathy
(NPDR)
Any of the following:
More than 20 intraretinal hemorrhages in each of four
quadrants
Definite venous beading in two or more quadrants
Prominent Intraretinal Microvascular Abnormalities
(IRMA) in one or more quadrants
And no signs of proliferative retinopathy
Severe Nonproliferative Diabetic
Retinopathy (NPDR)

Venous beading
Proliferative Diabetic Retinopathy (PDR)

Characteristics
• Neovascularization
• Vitreous/preretinal
hemorrhage
PROLIFERATIVE
DIABETIC
Cotton-wool
RETINOPATHY spot

Neovascularization

Neovascularization Hard exudate

Blot hemorrhage