Atlas of Ophthalmology

Proliferative Diabetic Retinopathy with Rubeosis Iridis (Colour Photo, FFA, OCT)

Systemic Diseases -> Endocrine Disorders -> Diabetes Mellitus -> Retina -> Proliferative (PDR)
Patient: 55 years of age, female., BCVA 0.5 at OD 0,3 at OS; IOP 16 at OD, 18 at OS. General medical history: Diabetes since 27 years, insulin therapy, Hba1c 13%; Ocular medical history: empty. Main complaint: decrease of vision at both eyes Purpose: to present diabetes induced changes of the anterior and posterior segment. Methods: Colour Photography Anterior Segment, Colour Fundus Photography, Fluorescence Angiography, SD-OCT. Findings: Colour Photography Anterior Segment : showing a neovascularization at the iris border at 11 o‘clock (arrow). Colour Fundus Photography 45°: showing neovascularization at the optic disk (1), retinal hemorrhages (2), retinal microinfarcts (3), and hard exsudates (4). Colour Fundus Photography 15°: showing a neovascularization at the optic disk. Fluorescence Angiography: showing macular ischemia with dropout of macular capillaries. SD-OCT: showing a focal hyperdensitity of a retinal microinfarct. Discussion: It was shown by Liu et al. (1) that progression and regression of DR were strongly associated with blood pressure and glycemic exposure. In a huge study they investigated the progression and regression of diabetic retinopathy (DR) and the effects of population risk factors on the rates of transition across retinopathy stages. From 1990 to 2011 4,758 diabetic patients who were diagnosed at 35 years of age or older were observed. They found a consistent risk effect of HbA1c on the progression from no retinopathy to mild background DR a hazard ratio per SD of HbA1c of 1.42, from mild BDR to observable BDR a hazard ratio of 1.32, and from observable BDR to severe nonproliferative/proliferative DR a hazard ratio of 2.23. Similarly, systolic blood pressure (SBP) and diastolic blood pressure increased the risk for the transition from the asymptomatic phase to mild BDR with a hazard ratio of 1.20 and from the mild BDR to observable BDR with a hazard ratio of 1.87, respectively. Regression from mild BDR to no DR was associated with lower SBP and lower HbA1c . Literature: (1) Liu Y, Wang M, Morris AD, Doney AS, Leese GP, Pearson ER, Palmer CN. Glycemic Exposure and Blood Pressure Influencing Progression and Remission of Diabetic Retinopathy: A longitudinal cohort study in GoDARTS. Diabetes Care. 2013 Oct 29.

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