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01-06-2013, 10:41 AM

Above is shown a typical picture of diabetic retinopathy. There are hemorrhages scattered throughout the retina as well as edema and exudates, or fluid collections.


Retinopathy is a readily visible sign of widespread microvascular disease. After 20
years of diabetic life virtually all patients will have evidence of background
retinopathy, but by contrast proliferative changes only ever develop in approximately
30% of people with diabetes, and they may represent a subset with a specific
inherited susceptibility to the disease. Diabetes may threaten sight by one of two
1. Macular oedema:
As detailed earlier, increased vascular permeability is a feature of microvascular
disease. Certain individuals appear to be predisposed to developing capillary leakage
at the macular and this leads to tissue oedema, structural disruption of the
photoreceptors and ultimately to visual disturbance. These leaking capillaries can be
identified by fluorescein angiography and photocoagulated with focal laser. Once the
leaking areas have been successfully treated the oedema resolves with usually some
improvement in vision.
2. Retinal ischaemia:
Retinal ischaemia can impact on vision in one of two ways
1. The retinas response to ischaemia is to generate angiogenic factors, which stimulate
new vessel formation with the intention of reperfusing the ischaemic areas.
Unfortunately these new vessels are unsupported and therefore have a propensity
to bleed. Visual loss due to preretinal or vitreous haemorrhage is the immediate
consequence of this; the long term sequelae includes the proliferation of fibroblasts,
the formation of fibrotic membranes, retinal traction and ultimately retinal
detachment. Ischaemic changes are also responsible for one of the late and very
serious conditions seen in people with diabetes; rubeosis iridis. Pan-retinal
photocoagulation (PRP) laser therapy is intended to reduce the propensity to new
vessel formation by destroying the ischaemic retina rendering it incapable of
synthesizing the angiogenic factors that drive the whole process.
2. Retinal ischaemia at the central macula leads to loss of neural elements at the fovea.
This manifests clinically as the loss of central vision; ischaemic diabetic
maculopathy. Unlike macular oedema, ischaemic maculopathy is untreatable.

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