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IN THE NAME OF GOD Gholamali Naderian MD Isfahan University Of Medical Sciences Feiz Eye Center

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DIABETIC RETINOPATHY EPIDEMIOLOGY RISK FACTORS PATHOGENESIS CLINICAL FEATURES CLASSIFICATION MANAGEMENT

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Diabetic Retinopathy Epidemiology Two forms of diabetes are recognised: - Type 1 or juvenile-onset or insulin dependent - Type 2 or adult onset or non-insulin dependent One of the leading causes of blindness in ages 20 - 74 90% of patients with diabetes have type 2 diabetes

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Prevalence of Diabetic Retinopathy Type 1 diabetes - 71% Type 2 diabetes (not on insulin) - 39% Type 2 diabetes (on insulin) - 70% Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR)

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Adverse Risk Factors 1. Long duration of diabetes Obesity Hyperlipidaemia 2. Poor metabolic control 3. Pregnancy 4. Hypertension 5. Renal disease 6. Other Smoking Anaemia

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PATHOGENESIS

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Pathogenesis Microangiopathy which has features of both microvascular leakage and occlusion Larger vessels may also be involved

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Pathogenesis Microvascular occlusion The changes leading to occlusion are: basement membrane thickening, endothelial cell damage deformed RBCs causing decreased oxygen transport changes in platelets leading to increased stickiness and aggregation

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Pathogenesis of diabetic retinopathy

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Pathogenesis Microvascular leakage Reduction in the number of pericytes resulting in capillary wall distention producing microaneurysms Breakdown of blood-retinal barrier results in leakage of plasma constituents into the retina

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Consequences of chronic leakage

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Pathogenesis Microvascular occlusion Capillary non-perfusion, retinal ischaemia and retinal hypoxia Production of vasogenic factors like Vascular Endothelial Growth Factor(VEGF) VEGF stimulates the growth of shunt and new vessels

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Consequences of retinal ischaemia

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Location of lesions in background diabetic retinopathy