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