Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Diabetes Mellitus, Type 2 Diabetic Retinopathy 479

■Nephropathy: develops in 10–40%, best treated by near-normal glu-

cose control, BP management, and use of ACE inhibitor; ESRD in

50–75% with nephropathy

■Atherosclerosis:

➣CAD, CVD, 2–4 fold higher

➣Peripheral vascular disease 4–6 fold higher

➣Best prevented by aggressive BP and lipid management, aspirin,

ACE inhibitor

Diabetic Retinopathy.................................

LAWRENCE J. SINGERMAN, MD, FACS, FICS and

JOAN H. HORNIK, AB

history & physical

History

■Leading cause of new cases of blindness in working-age people;

∼6000/y but possibly higher

■Risk of blindness due to diabetes related to age at diagnosis of dia-

betes & duration of disease:

➣12% of pts w/ insulin-dependent diabetes for≥30 y are blind

➣97% of pts w/ insulin-dependent diabetes for≥15 y have re-

tinopathy

➣Increasing incidence of diabetes increases risk of retinal blind-

ness

■Two main categories:

➣Background diabetic retinopathy (BDR) or nonproliferative dia-

betic retinopathy (NPDR):

Characterized by damage to small retinal blood vessels w/ sub-

sequent leakage of blood or fluid into retina

Most visual loss at this stage due to macular edema

Poor perfusion in macula can cause visual loss

➣Proliferative diabetic retinopathy:

Characterized by neovascularization (growth of new blood ves-

sels on optic head or in periphery)

Any of manifestations of BDR may be present

If untreated, vessels may continue to proliferate & enlarge,

leading to visual loss or blindness from

Rupture w/ subsequent preretinal or vitreous hemorrhage