Monday, December 15, 2008

Diabetic Retinopathy

Diabetic Retinopathy refers to retinal changes seen in patients with Diabetes Mellitus.
It is the leading cause of blindness worldwide.

Risk Factors includes;

1. Duration of diabetes
2. Sex in which female > males (4:3)
3. Poor metabolic control
4. Heredity
5. Pregnancy
6. Hypertension
7. Other; smoking, obesity, hyperlipidaemia.

DR is essentially a 'microangiopathy' affecting retinal precapillary arterioles, capillaries, & venules. The speculative pathogenesis is depicted in the flow-chart;

Vascular changes seen in DM
  • thickening of capillary basement membrane
  • capillary endothelial cell damage
  • changes in RBCs
  • increased stickiness of platelets
  • loss of capillary pericytes

this loss of pericytes will causes loss of architecture of the micro vessels thus will cause,
Microvascular occlusion

which will then lead to,
Retinal Ischaemia
&
Capillary leakage
Microaneurysm
Haemorrage
Retinal oedema
Hard exudates
Arteiovenous shunt ( Intraretinal Microvascular Abnormalities - IRMA )
Neovascularization

Classification

Latest Classification of Diabetic Retinopathy are as follows;

1. Non Proliferative Diabetic Retinopathy (NPDR)
- Mild NPDR
- Moderate NPDR
- Severe NPDR & Very Severe NPDR

2. Proliferative Diabetic Retinopathy (PDR)
3. Diabetic Maculopathy
4. Advance Diabetic Eye Disease (ADED)

hmm.. i got this from Dr Fariza Ngah, Consultant Ophtalmologist (Medical Retinal Diseases) Hospital Selayang, during my attachment there. There's a lot of info from her slides actually, but i put this on first. Our research project during elective posting in Hospital Selayang is regarding Diabetic Eye Complications... and Diabetic Retinopathy is among the hot topic discussed nowadays. One of the consultant mentioned that the Diabetes is the most popular topic to be discussed and even the PTK questions (the competency test for government servant) also asked them on Diabetes.

I'm very grateful dat i have a chance to do elective posting in this department.
( Department of Ophtalmology Hospital Selayang, National Referral Centre of Ophtalmology).

Everybody...( including the Head of Department, Consultants, Specialists, PostGraduate Trainees, and Medical Officers) gather around 7.30am and do the ward rounds, or CME, or Case Presentations, and they finished it all around 8.45am. Then all of them going breakfast together and about 9.00am all of them go to the clinics or OT together gether...which I found it is sooooo harmonious working in this department. It seems to be less stressful and everybody enjoying their work and also teach each other (which i haven't seen in any of my clinical traning hospital before. They are not only helpful to each other, but also willing to teach us, the elective students whom they never know before.. Best kan?

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