diabetic-retinopathy-pathogenesis-and-clinical-findings

diabetic-retinopathy-pathogenesis-and-clinical-findings

Diabetic Retinopathy: Pathogenesis and clinical findings
Family History of T1DM Genetics: (DR3,DR4,DQ non-asp genes) Ethnicity: White youth, African American, Hispanic, Asian-Pacific Islanders, and American Indigenous
Type 1 Diabetes Mellitus
Family History of T2DM History of Gestational Diabetes ‘1’ Body Mass Index t Age Polycystic Ovarian Syndrome Ethnicity: Indigenous Americans, African American, Hispanic
Time (-10 years after onset) Poor glycemic control Hypertension Dyslipidemia
Type 2 Diabetes Mellitus
Authors: Graeme Prosperi-Porta Reviewers: Stephanie Cote Usama Malik Johnathan Wong* * MD at time of publication
Abbreviations: • T1DM — Type 1 diabetes mellitus • T2DM — Type 2 diabetes mellitus • DR — Diabetic retinopathy • BRB — Blood-retinal barrier • RPE — Retinal pigment epithelium • VEGF — Vascular endothelial growth factor
• Diabetic Retinopathy Localized Outpouchings of the weakened capillary walls or endothelial buds attempting to re-vascularize the ischemic retina Micro-aneurysms Mild Non-proliferative DR Weakened BRB allows for rupture into the deeper retinal layers Dot/blot Hemorrhages Yellow lipid deposits with sharp margins due to lipoproteins and other proteins leaking through the damaged BRB Moderate Non-proliferative DR Hard Exudates Pericyte death, breakdown of endothelial tight junctions, and basement membrane thickening damages BRB • Nerve fiber layer infarcts from occlusions of the precapillary arterioles Cotton-wool spots Severe Non-proliferative DR Retinal hemorrhages occurring in the more superficial nerve layer 4 • Flame Hemorrhages Focal areas of saccular venous bulges due to significant retinal ischemia Venous beading Proliferative DR 47 Damaged BRB leaks fluid into the retinal tissues retinal ischemia causes upregulation of VEGF causing fine, irregular, and easily friable neovascularization in the disc, macula, and/or retina Traction Retinal Detachment Vitreous Hemorrhage Neovascularization • Macular Edema