By ULY CLINIC
Diabetic Retinopathy
​
Introduction
​
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
​
Diabetic retinopathy is mainly grouped into three stages/presentations:
-
Background diabetic retinopathy
-
Diabetic maculopathy
-
Proliferative diabetic retinopathy
​
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
​
-
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.
​
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.
​
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
​
Laser Treatment
Laser photocoagulation: Extent and type of this treatment depending on the stage of the disease
​
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
​
Updated on, 2.11.2020
​
​
References
​
1. STG