Classification of Diabetic Retinopathy

Abstract

A review of the literature on the classification of diabetic retinopathy shows that a consensus of opinions is not attained. Therefore it is impossible to compare the results of different works. Most of the classifications are based on purely anatomical criteria (ophthalmoscopic or photographic). The authors propose to base the classification of diabetic retinopathy on angiographic criteria. They consider that only fluorescein angiography can take into consideration the functional evaluation of the retinal circulation with unquestionable pathogenic correlation and adapted treatment: edematous diabetic retinopathy corresponds to capillary dilatation and ischemic diabetic retinopathy corresponds to capillary occlusion. Macular diseases are classified according to these same criteria.

Aqueous Flare and Retinal Capillary Changes in Eyes with Diabetic Retinopathy

“…As both lesions usually ap pear before neovascularization develops, they are believed to represent the primary microvascular disease manifesta tions [5].…”

“…Retinal vasodilation results in vessel wall alterations, which lead to increased vessel permeability, to the devel opment of microaneurysms and to transudation of fluid into the extravascular space [5]. Increased permeability of al tered retinal and iridal vessels appears to be the cause of increased flare in diabetic eyes.…”

“…Capillary occlusion and dilation with exu dation are prominent features of diabetic retinopathy. In nonproliferative diabetic retinopathy intraretinal edema corresponds to capillary dilation and ischemic diabetic reti nopathy corresponds to capillary occlusion [5], It was the To indicate the extent o f argon laser treat ment, the numbers o f previous laser burns in diabetic eyes were also analyzed. As control group, 108 normal eyes of 108 subjects (58 males, 50 females, age 53±13 years, age range 22-78 years) were investigat ed.…”

A game changer for eye care for diabetes

“…Such early detection of DR by FA does not add information for management and should only be used as a research tool. As a research tool, FA is useful in understanding clinico-pathologic changes in the retinal circulation of eyes with DR, in classifying DR [449][450][451] and to predict progression from baseline FA characteristics 35 , particularly patterns of capillary non-perfusion 450;452 . All ETDRS patients had FA to identify sources of leak in patients with DME and to assess the severity of the retinopathy 449 .…”

Isoxsuprine in Nonproliferative Diabetic Retinopathy: Effect on Human Retinal Circulation Assessed by Fluorescein Angiography—A Pilot Study

“…With increasing duration of the diabetes mellitus, both the prevalence and severity of the retinopathy increase markedly. 1-3 3 Early detection and information about the early development of retinal changes are important, not only because they relate to the eye but also because microvascular alterations may be present in other organs sumultaneously with the retinopathy.4 The deterioation of the microcirculation, most striking in the retina, might be due to abnormal blood rheology combined with certain alterations in the small vessels. 5 The consequence of high blood viscosity is most evident in the microcirculation, for it slows blood flow.…”