Classification and treatment of Diabetic Retinopathy

Diabetic Retinopathy can be divided into various sub-types Background diabetic retinopathy Diabetic maculopathy Proliferative diabetic retinopathy

Mild non-proliferative diabetic retinopathy Microaneurysms commonest Rarely macular oedema

Background Diabetic Retinopathy

Moderate non-proliferative diabetic retinopathy Microaneurysms Cotton wool spots Superficial flame shaped haemorrhages Venous changes IRMA

Severe non-proliferative diabetic retinopathy IRMA Venous beading Blotch haemorrhages In more than two quadrants of retina

Management of severe NPDR ETDRS results suggest that PRP may be considered Associated risk factors :- Type 1 diabetes mellitus Arterial hypertension Pregnancy Lack of compliance Diabetic nephropathy

Classification of diabetic maculopathy and macular oedema Focal exudative macular oedema Diffuse exudative macular oedema Ischaemic maculopathy Mixed forms

Diabetic maculopathy causes 90% of visual loss from diabetes - but these patients retain navigating sight

Treatment of focal exudative macular oedema

Treatment of diffuse macular oedema

Treatment of ischaemic diabetic maculopathy

Proliferative Diabetic Retinopathy New vessels elsewhere (NVE) New disc vessels (NVD) High risk proliferative diabetic retinopathy - New vessels ( NVE/NVD) - Preretinal haemorrhage

Proliferative retinopathy causes total blindness in 70% of untreated eyes after 5 years onset of neovascularisation

Treatment of NVE Mild NVE – focal treatment Severe NVE – PRP (600 – 800 burns)

Treatment of NVD PRP 1500 – 3000 burns

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