Useful notes for medical students
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Management of diabetic retinopathy
Management of Diabetic Maculopathy
Focal laser
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Treatment of microaneurysms associated with clinically significant macular edema is essential in preventing severe vision loss in patients with nonproliferative diabetic retinopathy
Management of the following is also crucial:
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Blood glucose levels
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Blood pressure
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Lipid levels Renal function
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Anemia
Patients with clinically significant macular edema have a 62% chance of moderate vision loss over a 3-year follow-up period, which is reduced to 28% with focal laser treatment of microaneurysms.
Intravitreal anti VEGF
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These block effects of VEGF and can reduce macular edema, retinal and iris neovascularisation
Periocular steroid injection
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Local corticosteroid therapy with periocular or intravitreal administration of triamcinolone has been shown to reduce macular edema, perhaps by stabilizing the blood-retinal barrier. Triamcinolone injections may need to be repeated if macular edema persists or recurs.
Management of Proliferative diabetic retinopathy (PDR)
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Treatment of PDR involves Pan Retinal laser photocoagulation Up to 2000 laser burns are placed on the retina. Further treatment is dependant on the response.
Figure 1 showing multiple laser burns.
Why do we treat proliferative diabetic retinopathy ?
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Vascular endothelial growth factor (VEGF) elaborated by an ischemic retina induces retinal neovascularization. These newly formed vessels then erupt through the surface of the retina (internal limiting membrane) and grow on the vitreous cortex "scaffold".
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They have the tendency to bleed with vitreous movements and the synchysis (ie, shrinkage) that occurs normally with age, causing vitreous hemorrhage. Such hemorrhage causes subacute and acute loss of vision and visual field; patients may complain of floaters or veils, or both, across their central or peripheral field of vision.
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Organization of hemorrhage on the vitreous cortex or formation of fibrovascular tissue on the vitreous cortex and retina can cause tractional retinal detachment and permanent loss of vision.
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As in nonproliferative retinopathy, macular edema and ischemia can lead to vision loss as well.
