Diabetic ophthalmopathy
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Transcript of Diabetic ophthalmopathy
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YOUSAF ALIYOUSAF ALI
LECTURER(DOCTOR OF LECTURER(DOCTOR OF OPTOMETRY)OPTOMETRY)
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Objectives of Objectives of presentationpresentation
Diabetes is one of the global health Diabetes is one of the global health challenges, affecting about 3 % challenges, affecting about 3 % population of the world.population of the world.
Diabetic ophthalmopathy – a Diabetic ophthalmopathy – a common, sight-threatening common, sight-threatening complication of diabetes. complication of diabetes.
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DIABETES MELLITUS:
TYPE 1 (IDDM) ------- Insulin dependent diabetes mellitusTYPE 2 (NIDDM) ---- Non Insulin dependent diabetes mellitus
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SYSTEMIC EFFECTS OF DIABETES
STROKE
CORONARY ARTERY DISEASENEPHROPATHY
PERIPHERAL VASCULAR DISEASEPERIPHERAL NEUROPATHY
DIABETIC DIABETIC OPHTHALMOPATHYOPHTHALMOPATHY
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EXTRA RETINAL EFFECTS OF
DIABETES ON EYE
LidsStyesChalazionXanthelasmas
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Lens
Cataract
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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CorneaKeratitisRecurrent corneal erosionPersistent epithelial defects
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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Refractive ErrorOsmotic swelling of lens causes myopic shift.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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Glaucoma
Angle closure glaucoma
Neovascular glaucoma
Blood associated glaucoma
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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Vitreous humor
Asteroid hyalosis
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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Occlusive retinal vascular diseases
CRAOCRVOBRAOBRVO
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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CRVO
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BRVO
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BRAO
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CRAO
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OPTIC NERVE
Acute disc oedema Mild acute AION Optic nerve hypoplasia Optic atrophy
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Cranial nerve palsies
Focal small vessel occlusion & ischaemic demyelination---- cause
Occulomotor Trochlear
& Abducent nerves palsies.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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3RD NERVE PALSY
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Infectious diseases
ENDOPHTHALMITIS MUCORMYCOSIS cause internal and external ophthalmoplegia, Proptosis, ptosis. HERPES ZOSTER INFECTION may affect the trigeminal nerve. Cause Uveities and keratits.
EXTRA RETINAL EFFECTS OF DIABETES ON EYE
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Diabetic Diabetic RetinopatRetinopathyhy
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TYPES OF DIABETES MELLITUS AND
OCULAR INVOLVEMENT
Diabetic RetinopathyType 1 Diabetics 40%Type 2 Diabetics 20%
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Diabetic Retinopathy
EPIDEMIOLOGY
Prevalence increases with duration of diabetes & age. After 20 years of diabetes, 99% pts with IDDM & 60% with NIDDM—have some degree of retinopathy. 70-80 million people affected worldwide. 5-8% population of Pakistan is affected. 5-10% of all diabetics have sight-threatening retinopathy.
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CLINICAL CLASSIFICATION OF DRDisease Severity Scale
• No Retinopathy • NPDR
MildModerate Severe
• PDR• ADED• EDED
AMERICAN ACADEMY OF OPHTHALMOLOGY
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RISK FACTORS
Onset / Duration of Diabetes:
DM before 30yrs of age —----
incidence 50%
DM after 10yrs ----- incidence
90% Type of Diabetes ( IDDM --- 40%,
NIDDM-----20%) Age -----higher risk of PDR in younger
diabetics. Sex ------Men with IDDM have ↑ risk of
developing PDR.
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Diabetic Control Nephropathy Hypertension Hyperlipidemias Cigarette smoking Pregnancy
RISK FACTORSCONT’D
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DIABETIC MICROANGIOPATHY
High Blood Sugar
COMPLICATIONS:• Ocular / Retinal• Renal• Neuropathic• Peripheral Vascular
Capillary Leakage Capillary Closure
Structural damage &Functional failure
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Pathogenesis of diabetic retinopathy
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Consequences of retinal ischaemia
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Consequences of chronic leakage
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BGDR CLINICAL FEATURES
Micro-aneurysm Intra retinal haemorrhages Hard exudates Retinal oedema
Micro-aneurysm
Intra retinal haemorrhages
Hard exudates Retinal oedema
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MANAGEMENT (BGDR)
Proper diabetic control Proper management of hypertension, anaemia and renal disease. Observations for
Maculopathy Ischaemia New vessels
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DIABETIC MACULOPATHY
“Involvement of fovea by oedema & hard exudates
or Ischaemia.”
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MACULOPATHY
Focal Diffuse Ischaemic Mixed
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Focal diabetic maculopathy
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Diffuse diabetic maculopathy
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Ischemic diabetic maculopathy
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Mixed Maculopathy
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PRE-PROFLIFERATIVE DR
CLINICAL FEATURES Large blot haemorrhages Venous changes--- dilatation, beading, looping IRMA Capillary non-perfusion
MANAGEMENT Close observation Laser on progression
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Preproliferative diabetic retinopathy
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PROLIFERATIVE DR
NVDNVEVitreous/Pre-retinal
hemorrhage
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Proliferative diabetic retinopathy
Neovascularization of disc = NVD
• Affects 5-10% of diabetics
• IDDM at increased risk (60% after 20 years)
Neovascularization elsewhere = NVE
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NVD NVD + NVE
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LASER TREATMENT FOR PDR
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Neo-vascularization in DR
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Principle of PRP
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PRP
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ADVANCED DIABETIC EYE DISEASE
Persistent new vessels Tractional retinal detachment Neovascular glaucoma
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Persistent new vessels
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Tractional RD
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Neo-vascular Glaucoma
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END STAGE DIABETIC EYE DISEASE
Phthisical eye
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INDICATIONS FOR VITREO-RETINAL SURGERY
Retinal detachment involving macula
Severe persistent vitreous haemorrhage
Dense, persistent premacular haemorrhage
Progressive proliferation despite laser therapy
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PPV for DR
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FOR YOUR TIME & ATTENTION