糖尿病视网膜病（全英）课件

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1、DiabeticRETINOPATHYProf.RajVardhanAzadDiabetes:GlobalPerspectiveDiabetes–ChallengesTotalnoofpeoplewithdiabetesisprojectedtorise171million2000to366millionin2030DRisthe3rdleadingcauseofvisualimpairmentamonginnercityAdults≥40yrsofage.BiochemicalmechanismsCapillaro

2、pathyHaematologicalchangesMicrovascularocclusionPATHOGENESISDR糖尿病视网膜病的发病机理ANGIOGENICFACTORSHypoxia↑VEGFBRBbreakdownAndnewvesselformation组织缺氧血管内皮细胞生长因子数量上升视网膜屏障与新生血管形成CLINICALFEATURES临床特征Microaneurysms微动脉瘤Hemorrhages眼底出血SoftExudates血管软性渗出VenousCaliberAlterations

3、静脉管径改变IntraretinalMicrovascularabnormalites视网膜微血管异常NewVessels新生血管的出现MacularEdema黄斑水肿Microaneurysms微动脉瘤的形成SorbitolAndFreeRadicalAccumulationDestructionOfPericytesMicroaneurysm山梨糖醇与游离基的聚集外膜细胞受到破坏微动脉瘤形成Hemorrhages眼底出血的形成DotandBlotTheyoccurindeepercapillaryplexusan

4、dspreadantero-posteriorlylikeacylinderNewVesselsBuddingendothelialtubulesfromvenousendofthecapillarybedNVE–NeovascularisationelsewhereNVD–NeovascularisationofthediscMacularEdemaFocalDiffuseETDRSClassificationNPDRMildModerateSevereVerySeverePDRWithoutHRCWithHRCA

5、dvancedMacularEdemaCSMEMicroaneurysmsMildtomoderateIntra-retinalhaemorrhagesin<4quadsHardexudatesMacularoedemaFovealavascularzoneabnormalitiesCotton-woolspotsIntraretinalhaemorrhagesin4quadrantVenousbeadingIRMASevereintraretinalhemorrhagesin4quadrantsVenousbead

6、ingin2quadrantsModeratelysevereIRMAin1quadrant“4-2-1Rule”SevereNPDR:Any1oftheaboveVerySevereNPDR:Any2oftheaboveNVDNVEPreretinalhemorrhagesVitreoushemorrhagesTractionalretinaldetachmentNVI/NVA/orbothNVDatleast¼-1/3discareainextentNVDwithpreretinalorvitreoushemor

7、rhageNVEatleast½discareasinextent&associatedwithpre-retinalorvitreoushemorrhage.InvestigationsVisualAcuityandRefractionSlitLampSlitLampBiomicroscopywith+90DlensIndirectOphthalmoscopyFundusFlouresceinAngiography(FFA)OpticalCoherenceTomographyFFAinDRAlwaysonfirst

8、visitClinicalSuspicionConfirmanddocumentType/LocationetcTreatmentAndonFollow-up:ForactivityToconfirmresolutionDiseaseworsening/complicationsFFAinDRNoDRDiffuseDiabeticMacular