KOMPLIKASI

DIABETES MELITUS
PADA MATA
HYASINTA ARLETTE NIKITA
VISUAL IMPAIRMENT, PAINFULL
EYE AND BLINDNESS
DIABETIC RETINOPATHY
■ Microvascular disease that involves damage of the retinal capillaries with secondary
visual impairment
(not so fun) Facts part 1
■ Prevalensi DR : 103 juta pada 2020 --> diperkirakan 161 juta pada 2045
■ 30% pasien type 2 diabetes SUDAH menderita retinopati pada saat
terdiagnosis DM
■ DM tipe 1 DR sebesar 77.3%
■ DM tipe 2  DR sebesar 25.1%
■ 25 to 30% dari keseluruhan DR mengalami vision-threatening diabetic
macular edema
■ prevalence of any retinopathy :
– 8% dalam 3 tahun,
– 25% dalam 5 tahun
– 60% dalam 10 tahun, and
– 80% dalam 15 tahun
Guidelines
AAO dan American Diabetes Association :

– type 1 diabetes  comprehensive dilated eye examination (dilakukan oleh

dokter spesialis mata) within 5 years of disease onset.

– type 2 diabetes  comprehensive dilated eye examination at the time of

diagnosis and yearly thereafter.

– Wanita baik dengan type 1 or 2 diabetes  comprehensive dilated eye

examination sebelum hamil atau pada trimester pertama
Follow up setiap 1 tahun

Follow up setiap 6-8 bulan

Follow up setiap 3-4 bulan, OCT dan foto

fundus

Follow up sesuai anjuran spesialis mata

KOMPLIKASI DARI DIABETIC RETINOPATHY

■ DIABETIC MACULAR EDEMA REVERSIBLE

■ VITREOUS HEMORRAGE*) VISUAL
IMPAIRMENT

■ RETINAL DETACHMENT
■ VITREOUS HEMORRAGE
IRREVERSIBLE
■ GLAUKOMA NEOVASKULAR VISUAL
IMPAIRMENT
Foto Fundus
OCT (Optical Coherence Tomography)
Patients may experience
DIAGNOSIS

- ONSET
- STATUS GLIKEMIK
- COMPLIANCE
INTERNIST/ENDOCRINOLOGIST OR
OPTHALMOLOGIST?
KEY WORD : CONTROLLED/ UNCONTROLLED DM

EVERY UNCONTROLLED DM NEEDS TO SEE AN IMS OR ENDOCRINOLOGIST

FIRST

EVERY CONTROLLED DM WITH VISUAL COMPLAINS NEEDS TO SEE AN

OPTHALMOLOGIST FIRST
(NOT SO FUN) FACTS (part 2)
■ DR + microalbuminuria  auxiliary diagnostic index for DN.
■ PDR independent predictor of other severe diabetic complications such as
ischemic stroke
■ The meta-analysis  severe DR (PDR or NPDR), was associated with a
fourfold higher risk of composite mortality and cardiovascular disease (CVD)
outcome
■ Hu et al. stroke risk increases as DR stage and lesion severity increase
■ Individuals with DPN were 4.88 times more likely to have DR than those
without (41.5% vs. 8.5%); it has been also shown that nearly all PDR patients
have DPN
■ we can predict the presence/absence and severity of DN in diabetics based on
DR severity
MANAGEMENT AND TREATMENT
■ The Diabetes Control and Complications Trial  HbA1c level in the 6-7% MENURUNKAN
pregresivistas DR
■ Specified eye examination (Dilated eye examination, optical coherence tomography, Foto
Fundus)
■ Antiinflamasi topikal (tetes, suntikan subtenon, intravitreal)
■ Laser photokoagulasi
■ Anti VEGF (injeksi intravitreal)
■ Vitreoretina surgery
THE WORST FACTS
Pasien DM dengan kebutaan akibat DR
■ 4x lebih beresiko terjadi depresi
■ 1,7x lebih buruk compliance terhadap pengobatan diabetesnya
■ 3,7x lebih banyak drop out dari hemodialisa
■ 43% lebih sering ‘ER visit’ karena hiperglikemi, hipoglikemi, keluhan lain
■ Walaupun tingkat bunuh diri rendah  may cause prolong depression and affect the
helpers
PEARL

■ NEVER TOO EARLY, ALWAYS TOO LATE

■ KEBUTAAN AKIBAT DM ADALAH
PREVENTABLE BLINDNESS
Terima kasih