Diabetic retinopathy in pregnancy David Kinshuck Associate specialist ophthalmology Good Hope & www.diabeticretinopahty.org.uk Diabetic retinopathy in pregnancy
Diabetic retinopathy in pregnancy What is diabetic retinopathy Mechanisms Identification..screening Treatment Prevention Where next
What is diabetic retinopathy
What is diabetic retinopathy
High glucose Retinal ischaemia Capillary leakage & new vessel growth IGF1, other growth factors, smoking, blood pressure Capillary leakage & new vessel growth Retinal ischaemia
Capillary leakage & new vessel growth Retinal ischaemia, PREGNANCY, IGF1, other growth factors, smoking, blood pressure VEGF: vascular endothelial growth factor Capillary leakage & new vessel growth Loss of central vision Detached retina and blindness
http://www.diabeticretinopathy.org.uk/dmret .html
Screening for diabetic Red free Photographs Selected optometrists Some outpatient clinics
Screening for diabetic
Treatment or diabetic retinopathy when pregnant Laser (no anti-VEGF injections) Intravitreal steroids (injection into the eye) Controlling glucose, bood pressure, smoking, antioxidants
Laser
Prevention Nursing support Low HbA1c Pumps? glucose sensors
Makes the retinopathy worse Have to accept this Lowering HbA1c quickly Makes the retinopathy worse Have to accept this
Never let the control get poor Pumps, sensors, Where next Never let the control get poor Pumps, sensors, Effective nursing support Effective organisation Much more effective mental health care