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By ULY CLINIC

 

Diabetic Retinopathy

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Introduction

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Diabetic Retinopathy is a complication of diabetes mellitus in the eyes.

 

It is a chronic progressive sight-threatening disease of the retinal blood vessels associated with the prolonged hyperglycaemia and other conditions linked to diabetic mellitus such as hypertension 

 

Diagnostic Criteria

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Diabetic retinopathy is mainly grouped into three stages/presentations: 

  • Background diabetic retinopathy

  • Diabetic maculopathy 

  • Proliferative diabetic retinopathy 

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Investigations

  • Perform fundoscopy in a well-dilated pupil (Direct or indirect ophthalmoscopy with or without biomicroscopy), 

  • Fundus photography, 

  • Optical Coherence Tomography and or Fluorescein Angiography done in specialized eye clinics 

 

Note : Dilate the pupils with combined C: Tropicamide 1%/Phenylephrine 2.5% eye drops 

OR  

  • Tropicamide 1% with  C: Cyclopentolate 1% eye drops to screen 

 

Pharmacological Treatment

 

For glycaemic control give antioxidant in non-proliferative diabetic retinopathy  

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  • Multivitamin +carotenoids tablets once daily to a maximum of 3 months

 

For intravitreal anti Vascular Endothelial Growth Factor (VEGF) in Proliferative Disease

 

  • Bevacizumab 1.25 mg per 0.05ml stat

 OR

  • Ranibizumab 0.5 mg per 0.05ml stat.  

 

Repeat after every month to a maximum of 6 months. Re-assess on 3 monthly basis if there are signs of disease progression, restart treatment if any, with close follow up. 

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Note: These injections are only given by specialist eye surgeons.  

AND 

  • Injection Triamcenolone acetonide 0.05 ml intravitreal stat. Repeat after 3 months if it is necessary. This is indicated in Diabetic Macula Edema.  

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Surgical Treatment

  • This is done in the proliferative stage

  • It involves removal of vitreous and or blood, peeling of formed fibrovascular tissue and reattachment of retina if the retina is detached

  • It is combined with retinal photocoagulation

  • The vitreous cavity may be filled with temponade liquid such as silicon oil or expansile gas like sulfur perfluoropropane or hexafluoride depending on the level of complication

  • It may also be combined with pharmacological treatment (Anti VEGF) mentioned above 

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Laser Treatment

Laser photocoagulation: Extent and type of this treatment depending on the stage of the disease 

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Note: 

  • Ophthalmologists should work together with Physicians to holistically treat the diabetic patient. 

  • Poorly controlled diabetes and diabetic retinopathy can lead to blindness

  • All patients with diabetes mellitus regardless of their eye conditions, should have a thorough eye examination by available eye care personnel or an eye specialist at least once a year.

  • Dilated eye examination and direct viewing of the retina by an ophthalmologist or qualified eye care personnel is mandatory.

  • Urgent referral of all diabetic patients with sudden loss of vision to eye specialist 

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Updated on, 2.11.2020

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References

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1. STG 

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