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General Medicine

Retinopathy, Diabetic

Richard W. Allinson, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Noninflammatory retinal disorder characterized by retinal capillary closure and microaneurysms. Retinal ischemia leads to release of a vasoproliferative factor, stimulating neovascul...

DIAGNOSIS

HISTORY

Diabetic patients should be encouraged to have an annual ophthalmologic exam because early eye changes may be asymptomatic. 

PHYSICAL EXAM

  • Eye exam: measurement of visual acuity and doc...

TREATMENT

MEDICATION

  • Treatment with the angiotensin-receptor blocker candesartan has been shown to result in regression of DR in some patients.

  • Nutritional antioxidant intake of vitamins C and E and of ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

Scheduled ophthalmologic eye exams 

  • Yearly follow-up if no retinopathy

  • Every 6 months with background DR

  • At least every 3 to 4 months with pre-PDR

  • E...

REFERENCES

1
Wells JA, Glassman AR, Ayala AR, et al; and Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med.  2015;37...

SEE ALSO

Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2 

CODES

ICD10

  • E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

  • E10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema

  • E10.3...

CLINICAL PEARLS

Options for the treatment of diffuse macular edema include focal laser treatment, intravitreal triamcinolone, intravitreal ranibizumab, intravitreal bevacizumab, intravitreal afliberce...

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Related Images
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Image of the retina afflicted with proliferative diabetic retinopathy as seen through an ophthalmoscope.
Image of the retina afflicted with proliferative diabetic retinopathy as seen through an ophthalmoscope.
Figure 5.6. A: Fundus with diabetic retinopathy and neovascularization of the optic disc.
Figure 5.6. A: Fundus with diabetic retinopathy and neovascularization of the optic disc.
Figure 5.8. A: Cotton-wool spots located superotemporal to the optic nerve head.
Figure 5.8. A: Cotton-wool spots located superotemporal to the optic nerve head.
Figure 5.9. A: Multiple, discrete, yellow, hard exudates in the posterior pole of an eye with background diabetic retinopathy.
Figure 5.9. A: Multiple, discrete, yellow, hard exudates in the posterior pole of an eye with background diabetic retinopathy.
Figure 5.34. Retinal hemorrhages with background diabetic retinopathy. Most intraretinal hemorrhages are dot and blot types, although a streak hemorrhage in the nerve fiber layer can be seen superotemporal to the optic disc. Multiple foci of yellow, hard exudate are also evident.
Figure 5.34. Retinal hemorrhages with background diabetic retinopathy. Most intraretinal hemorrhages are dot and blot types, although a str...
Figure 14.60. Pretibial diabetic skin changes: necrobiosis lipoidica diabeticorum.
Figure 14.60. Pretibial diabetic skin changes: necrobiosis lipoidica diabeticorum.
Homeless diabetic man with painful foot showing gangrene and dystrophic nails
Homeless diabetic man with painful foot showing gangrene and dystrophic nails
FIG. 11 Diabetic patient with acute spontaneous onset of low back pain and fever. A,B: Dramatic elements of two-level spondylodiscitis, L3-5, with secondary communicating psoas abscess component.
FIG. 11 Diabetic patient with acute spontaneous onset of low back pain and fever. A,B: Dramatic elements of two-level spondylodiscitis, L3-...
Figure 11.93. Neuropathic (Charcot) joints in two diabetic patients. A. Radiographs of both feet show bilateral neuropathic joints at the first metatarsophalangeal joints (arrows). On the left there is periarticular osteopenia, indicating superimposed infection. Frontal (B) and lateral (C) knee radiographs of another patient show disintegration of the knee joint with considerable bony debris (" bag of bones") and a large joint effusion. In the past, involvement o...
Figure 11.93. Neuropathic (Charcot) joints in two diabetic patients. A. Radiographs of both feet show bilateral neuropathic joints at the f...
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
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