Diabetic Retinopathy and Maculopathy

Abstract

Epidemiology ! Diabetic retinopathy is a frequent microvascular complication of diabetes mellitus. Patients with Type 1 Diabetes ! ▶ Retinopathy is rare in children before puberty ▶ Up to 85 % of patients with diabetes for 25 years or more years may develop retinopathy ▶ Diabetic maculopathy is present in 15 % of patients with diabetes for more than 15 years Patients with Type 2 Diabetes ! ▶ Up to one third of patients are diagnosed as having mild retinopathy when diabetes is detected ▶ Nearly 80 % of patients develop retinopathy after 15 to 20 years ▶ Diabetic maculopathy can occur in nearly 25 % of patients Symptoms ! Diabetic retinopathy and maculopathy usually develop and progress without symptoms. Fundus screening is mandatory, since only advanced stages cause symptoms. Signs and symptoms that suggest the development of retinopathy are: ▶ sudden drop of visual acuity ▶ non-correctable drop of visual acuity If the macula is affected: ▶ impaired vision ▶ impaired colour vision ▶ blurred vision ▶ "floaters" seen in front of the eye; these are caused by vitreous haemorrhages or tractive retinal detachments. Risk Factors ! ▶ hyperglycaemia ▶ arterial hypertension ▶ diabetes duration ▶ hormonal changes (pregnancy, puberty) ▶ smoking ▶ concomitant nephropathy Early Worsening of Diabetic Retinopathy !Early worsening (euglycaemic re-entry) of retinopathy affects patients with type 1 diabetes. It is rare (< 5 % of the patients), occurs primarily during the first 12 months of metabolic improvement, and is more frequent in patients with diabetes duration > 10 years and long term poor glycaemic control (HbA1c > 10 %). It cannot be prevented by gradual improvement of HbA1c. The positive effect of improved glycaemic levels outweighs early worsening.

Related Risk Factors between Subclinical Carotid Atherosclerosis and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes Mellitus in China

“…In this study, we divided patients into DR and subclinical atherosclerosis co-existed, non-coexisted groups and showed that dyslipidemia might play a key role in the micro-and macro-vascular changes in newly diagnosed T2DM. Importantly, this was in addition to the classical, known risk factors for DR, such as and hyperglycaemia and diabetes duration [30]. According to the basic research, this result might be due to the fact that dyslipidemia leads to endothelial dysfunction, the increase of reactive oxygen species, and the inactivation of nitric oxide, i. e., oxidative stress [31][32][33][34][35].…”

The Role of Smoothened and Hh Signaling in Neovascularization

“…The first pathological change in diabetic retinopathy is decreased pericyte coverage of retinal capillaries and acellular capillaries representing apoptosis of pericytes and endothelial cells. In response to progressive retinal capillary dropout, the ischemic retina mounts an angiogenic response from the surrounding capillaries leading to proliferative diabetic retinopathy [86]. Impaired perfusion and retinal ischemia then causes upregulation of angiogenic molecules including VEGF, erythropoietin, and other vascular growth factors.…”

Effect of Chinese herbal compounds on ocular fundus signs and vision in conventional treated-persons with non-proliferative diabetic retinopathy: A systematic review and meta-analysis

“…NPDR is characterized by retinal hemangiomas, hemorrhages, hard exudates, cotton wool spots and IRMA signs, while PDR is characterized by retinal neovascularization, vitreous or preretinal hemorrhages (4). How to prevent and control early DR as well as to control the progression of NPDR to PDR and to maximize the protection and recovery of vision in patients with DR is a challenge and a hot topic of research for scholars.…”