1. Diabetic retinopathy in pregnancy
David Kinshuck
Associate specialist ophthalmology Good Hope &
Diabetic retinopathy in pregnancy

2. Diabetic retinopathy in pregnancy
What is diabetic retinopathy
Mechanisms
Identification..screening
Treatment
Prevention
Where next

3. What is diabetic retinopathy

4. What is diabetic retinopathy

6. High glucose Retinal ischaemia Capillary leakage & new vessel growth
IGF1, other growth factors, smoking, blood pressure
Capillary leakage & new vessel growth
Retinal ischaemia

7. 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

8. http://www.diabeticretinopathy.org.uk/dmret .html

12. Screening for diabetic
Red free Photographs
Selected optometrists
Some outpatient clinics

13. Screening for diabetic

14. Treatment or diabetic retinopathy when pregnant
Laser
(no anti-VEGF injections)
Intravitreal steroids (injection into the eye)
Controlling glucose, bood pressure, smoking, antioxidants

15. Laser

16. Prevention
Nursing support
Low HbA1c
Pumps?
glucose sensors

17. Makes the retinopathy worse Have to accept this
Lowering HbA1c quickly
Makes the retinopathy worse
Have to accept this

18. 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