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Diagnosis & Management of Diabetic Eye Disease

Diagnosis & Management of Diabetic Eye Disease. Part 6. A. Paul Chous, M.A., O.D., F.A.A.O. Tacoma, WA Specializing in Diabetes Eye Care & Education. Staging of Diabetic Macular Edema. DME Absent no retinal thickening or hard exudates in the posterior pole

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Diagnosis & Management of Diabetic Eye Disease

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  1. Diagnosis & Management of Diabetic Eye Disease Part 6 A. Paul Chous, M.A., O.D., F.A.A.O. Tacoma, WA Specializing in Diabetes Eye Care & Education

  2. Staging of Diabetic Macular Edema DME Absentno retinal thickening or hard exudates in the posterior pole DME Present some retinal thickening or hard exudates in the posterior pole Mild DME RT or HE in the posterior pole but distant from the macula Moderate DME RT or HE approaching but not involving the macular center Severe DME RT or HE involving the center of the macula

  3. Definition of CSMEClinically Significant Macular Edema • Retinal thickening within 500 microns (<1/3 DD) • of the foveal center and/or • 2. Hard exudates within 500 microns of the fovea with • adjacent retinal thickening and/or • 3. Retinal thickening > 1DD in size any part of which is • within 1DD of the fovea • Per Early Treatment of Diabetic Retinopathy (ETDRS) protocol • Important quantitative criteria that determine the need for focal or grid macular laser photocoagulation

  4. Diabetic Retinopathy/MaculopathyOptical Coherence Tomography • Tissue thickening • Cystic changes • Disruption of NFL • Monitor efficacy of Tx.

  5. Referral & Follow-up for DR • AOA Clinical Practice Guidelines (2002) recommend referral to a retinal specialist when: • Any DME • Severe NPDR • Iris neovascularization • Unexplained vision loss • PDR (stat referral if NVD > 1/4DD, or NVD/NVE with fresh vitreous hemorrhage

  6. Recommended Follow-up • Mild NPDR every year • Moderate NPDR Q 6-12 months • Severe NPDR (T1DM only) Q 3-4 months • DME < CSME Q 3-12 months • Adequately treated PDR: every year

  7. Treatment of DR - PRP • Pan-retinal Photocoagulation (PRP) is the ‘gold standard’ treatment for PDR • causes regression of neovascularization (11% lose 1 line of VA) • Meta-analysis of ETDRS data shows that treating severe NPDR with PRP benefits patients with T2DM only • New NV, fresh VH or failed regression of NV are indications for additional PRP • PRP reduced the risk of severe vision loss (<20/800) by 50-75% in the DRS

  8. Treatment of DR - PRP

  9. Treatment of DR - Vitrectomy • Vitrectomy indicated for: • Non-clearing VH precluding PRP • Significant vitreo-retinal traction • Severe PDR in younger patients with T1DM • 25 gauge instrumentation has revolutionized vitrectomy • Faster visual recovery & less inflammation 17g versus 25g

  10. Treatment of CSME • Focal or grid laser reduces the risk of substantial worsening of vision (doubling of the visual angle) by 50% (ETDRS) • Intravitreal triamcilnolone/Kenalog (IVTA/IVK) now commonly used alone or in tandem with laser to treat recalcitrant DME • Patients with PDR and DME typically treated for the DME first and/or receive IVK with PRP

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