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Diabetic Retinopathy : Introduction, Pathogenesis, Classification, Diagnosis, Treatment,Complications-
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Diabetic Retinopathy (DR) ๐๏ธ is a microvascular complication of diabetes that affects the retina, leading to vision impairment and potential blindness. It is caused by prolonged high blood sugar levels, which damage the blood vessels in the retina, leading to leakage, bleeding, and retinal ischemia. DR is a major cause of vision loss in adults, particularly those with long-standing or poorly controlled diabetes.
Pathogenesis :
The pathogenesis of diabetic retinopathy involves hyperglycemia-induced damage to retinal blood vessels, resulting in increased vascular permeability, capillary occlusion, and ischemia. Key mechanisms include oxidative stress, inflammation, and the activation of the protein kinase C pathway, which contribute to retinal microvascular damage and neovascularization ๐ฑ.
Classification :
Diabetic retinopathy is classified into two main stages:
Non-Proliferative Diabetic Retinopathy (NPDR): Characterized by microaneurysms, retinal hemorrhages, and exudates. In advanced stages, NPDR can lead to macular edema, the most common cause of vision loss in diabetes.
Proliferative Diabetic Retinopathy (PDR): This more severe form involves neovascularization, where new, fragile blood vessels form on the retinal surface, increasing the risk of vitreous hemorrhage, retinal detachment, and severe vision loss.
Diagnosis :
Diagnosis of diabetic retinopathy involves a comprehensive eye examination, including:
- Dilated Fundus Examination: To visualize retinal changes.
- Fundus Photography: To document and monitor disease progression.
- Fluorescein Angiography: To assess blood vessel leakage and ischemia.
- Optical Coherence Tomography (OCT): To evaluate macular edema and retinal thickness ๐ฌ.
Treatment :
Treatment aims to slow the progression and prevent complications:
- Glycemic and Blood Pressure Control: Essential for reducing the risk and progression of DR.
- Laser Photocoagulation: Used in PDR to seal leaking vessels and reduce neovascularization.
- Intravitreal Injections: Anti-VEGF agents (e.g., ranibizumab, bevacizumab) or corticosteroids to reduce macular edema and inhibit neovascularization.
- Vitrectomy: Surgical option for advanced PDR with vitreous hemorrhage or retinal detachment.
Complications :
Complications of diabetic retinopathy include:
- Vitreous Hemorrhage: Bleeding into the vitreous cavity, causing sudden vision loss.
- Tractional Retinal Detachment: Due to scar tissue pulling on the retina.
- Neovascular Glaucoma: Increased intraocular pressure from neovascularization blocking the drainage angle of the eye, leading to optic nerve damage.
- Permanent Vision Loss: From macular ischemia or untreated retinal detachment.
Understanding and managing diabetic retinopathy is crucial in preventing vision loss and improving the quality of life for individuals with diabetes.
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