Internal Medicine

P1: RLJ/OZN P2: KUF

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

480 Diabetic Retinopathy

Fibrous tissue formation w/ traction retinal detachment

&/or hole

Signs & Symptoms

■Microaneurysms

■Intraretinal hemorrhages

■Lipid exudates (sometimes called hard exudates)

■Intraretinal microvascular abnormalities

■Venous beading & loops

■Cotton wool spots (formerly called soft exudates)

■Capillary nonperfusion (occlusion of fine retinal capillaries)

■Neovascularization:

➣Disc (NVD)

➣Elsewhere (NVE)

■Retinal detachment:

➣Caused by retinal hole or tear (rhegmatogenous)

➣Caused by traction on retina

tests

Common

■Ophthalmoscopy

■Fundus photography

■Fluorescein angiography

Less Common

■Ocular coherence tomography

■Retinal thickness analyzer

■Visual fields

■Indocyanine green angiography

differential diagnosis

■Branch &/or central retinal vein occlusion

■Hypertensive retinopathy

management

General Measures

■Panretinal photocoagulation (PRP) in eyes with high-risk PDR: 1)

new vessels with preretinal or vitreous hemorrhage, 20 NVD≥1/4

to 1/3 disc area, even without hemorrhage

■Individualize PRP in eyes w/ non-high-risk PDR:

➣Rubeosis requires prompt PRP to prevent neovascular glaucoma

➣Early PDR or severe NPDR may be treated, particularly in