Proliferativ Diabetic Retinopathy 1


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Proliferative diabetec retinopathy


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Proliferativ Diabetic Retinopathy:

Proliferativ Diabetic Retinopathy Tasneem Ali Moh . 368

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Proliferative diabetic retinopathy (PDR) affects about 5-10% of the diabetic patients


Symptoms: Blurred vision Floaters and flashes loss of vision Areas of scotoma

Clinical Features:

Clinical Features The hallmark of PDR is the: Neovascularization Vitreous Haemorrhage Vitreous traction

Neovascularization :


Fibrous vascular proliferation :

Fibrous vascular proliferation Accompaining the growth of new vessels forming a fibrovascular “ Epiretinal membrane ” on the macular area of the retina Cluster Hg Fibrous tissue with localised traction NVE

Vitreous detachment:

Vitreous detachment The fibrovascular network becomes adherent to the posterior vitreous face and may cause Traction retinal detachments



Hg in the preretinal space (the retrohyaloid space) :

Hg in the preretinal space (the retrohyaloid space) Boat or crescentric shape

Hg in the preretinal space (the retrohyaloid space) :

Hg in the preretinal space (the retrohyaloid space)

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Hg in the vitreous cavity

Rubeosis Iridis:

Rubeosis Iridis New vessels on the iris They tend to invade the angle and root of the iris, causing secondary neovascular glaucoma.

Other signs that may be found in PDR::

Other signs that may be found in PDR: NVD Cotton wool IRMA Venous Beading Area of non perfusion

Other signs that may be found in NPDR::

Other signs that may be found in NPDR:

Diagnostic tests:

Diagnostic tests Photographs of the fundus 2. Optical coherence tomography scanning: particularly used for the diagnosis and management of CSME loss of central foveal depression (yellow arrow), accumulation of fluid at fovea (red arrow) vitreomacular traction: loss of foveal depression with traction on fovea

3. Fluorescein angiography: :

3. Fluorescein angiography: 4-B scan Ultrasonography microaneurysm Non perfusion NVD IRMAS Venous Beeding Macular ischemia Cystoid macular edema

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Clinically significant Macular Edema Focal treatment : is carried out for all lesions ( microaneurysms , IRMA or short capillary segments) 500-3000 microns from the centre of the macula

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Clinically significant Macular Edema Grid treatment: Grid pattern laser burns are applied in the macular area for diffuse diabetic macular oedema . Modified Grid : Both focal and grid

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Indications for treatment of PDR NVD > 25%-33% disc in area Less extensive NVD + haemorrhage NVE + haemorrhage Management of PDR

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1.Pan Retinal laser photocoagulation(PRP) >Laser burns are applied 2-3 disc areas from the centre of the macula extending peripherally to the equator The aim of treatment by laser photocoagulation is: To induce involution of new vessels Prevent recurrent vitreous haemorrhage

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Assessment after photocoagulation Persistent neovascularization Haemorrhage Poor involution Regression of neovascularization Good involution Further argon laser PRP filling in any gaps between previous laser scars. Cryotherapy

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2-PARS PLANA VITRECTOMY The indications for pars plana vitrectomy are the following: Severe persistent vitreous haemorrhage Tractional retinal detachment involving the macula.

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3-Pharmacological Treatment:

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