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Diabetic retinopathy ( diagnostics , therapy , classification ) Veronika Matušková

Diabetic retinopathy ( diagnostics , therapy , classification ) Veronika Matušková. Diabetes mellitus- definition. Diabetes mellitus is disease with high glucose level (hyperglycaemia) due to absolute or relative lack of insulin produced in beta cells of Langerhans pancreatic islets.

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Diabetic retinopathy ( diagnostics , therapy , classification ) Veronika Matušková

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  1. Diabeticretinopathy(diagnostics, therapy, classification)Veronika Matušková

  2. Diabetes mellitus- definition • Diabetes mellitus is disease with high glucose level (hyperglycaemia) due to absolute or relative lack of insulin produced in beta cells of Langerhans pancreatic islets

  3. Diabetes mellitus (late complications) • retinopathy • nephropathy • diabetic foot • neuropathy

  4. Diabetic retinopathy (definition) • Diabeticretinopathyismicroangiopathy, • HbA1c is very important

  5. Classification of diabetic retinopathy • Nonproliferative DR (NPDR) • Proliferative DR (PDR) • Diabetic maculopathy (M) (each level of diabetic retinopathy may or may not beaccompanied by diabetic maculopathy)

  6. Nonproliferative DR (NPDR) • Beginning • Intermediate • Advanced

  7. Beginning NPDR

  8. Intermediate NPDR

  9. Intermediate NPDR

  10. Advanced NPDR

  11. Proliferative DR (PDR) • Light • Intermediate • Fullyadvanced VH- vitreoushemorrhage, PRH- preretinalhemorhage, TRD- tractionalretinaldetachmentat center ofmacula

  12. Light PDR

  13. Intermediate PDR

  14. Fully advanced PDR

  15. Fully advanced PDR

  16. Vitreous hemorrhage in fully advanced PDR

  17. Fluorescein angiography

  18. Diabeticmaculopathy(M) • Macular area is a predilection site for edema formation • Microangiopathy leads to ischemia, fluid accumulation, formation of microcysts and cysts • Hard exudates (lipid accumulation) occur on the boundary of ischemic and normal retina

  19. Diabetic makulopathy (M)

  20. Diabetic makulopathy (classification) • Focal edema • Difuse edema • Ischemic edema (rare)- avascular zone in macula

  21. Focal edema

  22. Difuse edema

  23. Ischemic edema

  24. Macularoedema – laser therapy • Focal • Grid

  25. Focal laser

  26. Grid laser

  27. Macularoedema - anti VEGF • DME withoutreaction to laser therapy • Goodcompensationof DME • Lastingof DME < 2 years

  28. Therapyofdiabeticretinopathy • Gold standard is laser photocoagulationofischemicretinalparts – panretinalphotocoagulation • Laser can‘tbeperformed in centralmacularzone

  29. Laser spots in retina suffered from NPDR

  30. Surgical therapy of DR • Pars plana vitrectomy- (Machemer, Parel – 1970) – tractionalretinaldetachment, haemophtalmus

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