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Diabetic Retinopathy

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Abhijit Handique

on 10 September 2016

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Transcript of Diabetic Retinopathy

Diabetic Retinopathy
Dr Abhijit Kr Handique
Neglected due to Ignorance
Avoided because of complexity
Recapitulation
Trending Facts
Rx or Sx
Epilogue
of pathophysiology
In Diabetic Retinopathy workup
Of Diabetic Retinopathy
Looking to the future
Microaneurysms/ dot hge
Hard Exudates
Neovascularization elsewhere
Occluded vessels
Venous beading
IRMA / Early NV?
Laser Scars
Cotton Wool Spots
Neovascularization Disc
Blot hemorrhage
Indirect Ophthalmoscopy
+90 D biomicroscopy
Disc NV
NVE
CNP area
Capillary dropout
Budding NV
Venous abnormality
Strategic workup
ETDRS classification
OCT grading of ME
Clinically Significant Macular Edema
Moderate
Severe
Very Severe
Early PDR
High risk PDR
Location
Thickness/ Volume
Vitreo-retinal interface
Hard exudate
ETDRS ME classification
Medical
Lasers
Surgical
Topical
Systemic
Intravitreal
Nepafenac
Angiotensin Converter Enzyme Inhibitor :
ACEI
eg. Lisinopril
Angiotensin Receptor Antagonists
mecamylamine
fenofibrate
AntiVEGF
Monoclonal antibody
Bevacizumab (Avastin)
Antibody derivatives
Ranibizumab (Lucentis)
Aptamer
Pegaptanib (Macugen)
Oral Small molecules (inhibit tyrosine kinase)
Lepatinib
Sunitinib
Sorafenib
Fusion proteins
VEGF trap - eye (Aflibercept)
Misc
siRNA Bevasiranib, adPEDF
Argon
FD NdYAG
Diode
Platelet aggregation
BM thickening
Pericyte loss
aneurysm
leaky capillary
non resolving vitreous hemorrhage
Tractional RD/ Membrane
Vitreomacular traction/ nonresolving edema
3/4 port vitrectomy with procedures
EL, MP, ILMP, SF6, c3f8, SOI etc
Teleophthalmology for DR screening
High resolution OCT
Topical medications to reduce CSME & NV
Newer intravitreal drugs
Subthreshold Lx, Guided Lx
Evolving surgical techniques.....
Thank you
Capillary alteration
Capillary closure
Capillary leakage
Angiogenesis
Ischemic maculopathy
Retinal edema
Hemorrhage
Fibrous prol.
Major vessel changes
(venous beading/looping)
Vit Hge
Ret Traction
Ret tear
Aims of DR workup
Classify DR
Classification and analysis of Macular Edema
To detect ischemia and occult NV
Classification dictates the management and follow-up protocol
Risk of Visual Loss, prognosis and treatment protocol
Progression, unexplained VL
SVL
: <or= 6/60 Sn or 20/200 Ft @ 2 completed consecutive check up at 4 months interval
MVL
: Doubling of visual angle (eg 6/6 becoming 6/12) @ 2 completed consecutive check up at 4 months interval.
Mild
At least one MA
Features less than standard photo 2A
Feature > or = 2A
CWS, VB and IRMAs definitely present
< std ph 8A
H/MA > or = Std ph 2A @ 4 Qdt
VB in 2 Qdt
IRMA > or = Std Ph 8A in 1 Qdt
Any two or more features of of Severe NPDR
Presence of new vessels
NVD
NVE
NVD > or = 1/3 to 1/2 disc area
NVD of any size with VH or pre retinal Hge
NVE > or = 1/2 DD with VH or pre retinal Hge
Retinal thickening within 500 micron from fovea
HE within 500 micron from fovea with adjacent retinal thickening
Thickening >or = 1 DD within 1DD from fovea
S
: Subretinal fluid
A
: Area
V
: Vitreoretinal interface abnormality
E
: Etiology
Depot corticosteriod (TA/Dexamethasone)
Pharma vitreolytic agents (Ocriplasmin)
Full transcript