Diabetic retinopathy

Diabetic retinopathy is one of the leading causes of blindness. In France, 40 % of diabetics (nearly 1 million patients), have some degree of diabetic retinopathy.

Diabetic retinopathy

Diabetic retinopathy is caused by the occlusion of retinal capillaries which induces retinal ischemia and the creation of ischemia-induced neovascularization.

Diabetic maculopathy

The diabetic maculopathy is caused by the breakdown of the blood-retinal barrier and capillary leakage . Macular edema is responsible for vision loss.

Evolution

Diabetic retinopathy is classified into different stages:

  • Non proliferative diabetic retinopathy (NPDR): Mild stage, moderate or severe non proliferating diabetic retinopathy.
  • Proliferative diabetic retinopathy (PDR): presence of ischemia-induced neovascularisation found upon fundus exam.

Patients with Type 2 diabetes should have an ophtalmic examination upon diagnosis, including fundus examination after pupil dilation. This dilated fundus exam must be repeated at least once a year. Photography of the fundus and angiography with fluorescein allow to properly identify any damage. OCT (optical coherence tomography) allows analysis of macular edema.

Photography of retinal fundus in severe not proliferating diabetic retinopathy.
Photography of retinal fundus in severe not proliferating diabetic retinopathy.

Follow-up

Immediately after the discovery of diabetes, a fundus examination after pupillary dilation must be realized. This must be repeated at least once a year. Fundus photography and fluorescein angiography allow proper identification of any lesions. OCT (optical coherence tomography) aids in analysis of macular edema.

Fluoprescein Angiography in early proliferating diabetic retinopathy
Fluoprescein Angiography in early proliferating diabetic retinopathy

Treatments

A strict balance of glycemic controls and blood pressure are essential to avoid worsening of retinopathy and is beneficial in reducing disease progression rates. The target glycated hemoglobin ( HbA1C) is any value lower than 7 % and blood pressure readings lower or equal to 130/80 mmHg.

  • Laser treatment (pan retinal photocoagulation) is a preventive treatment in case of severe diabetic retinopathy or proliferative retinopathy. The goal is to cause regression of existing neovascular tissue by burning ischemic retinal area. Several sessions are necessary and their rhythm is determined by the severity of the disease.
  • A surgical treatment (vitrectomy) is indicated in case of intra-vitreous bleeding or in case of retinal detachment .

For macular edema that causes vision loss, macular grid laser remains the reference treatment. The intravitreal injections of corticoids or anti-VEGF can also turn out to be effective and vitrectomy may also be indicated in some cases.

Last page modification: 2 Sep 2013