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General Medicine

Retinopathy, Diabetic

Richard W. Allinson, MD and Francis Allinson, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

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

DIAGNOSIS

PHYSICAL EXAM

  • Eye exam: measurement of visual acuity and documentation of the status of the iris, lens, vitreous, and fundus

  • Nonproliferative (background) DR

    • Microaneurysms

    • Intraretinal hemorrha...

TREATMENT

GENERAL MEASURES

  • The Diabetes Control and Complications Trial (DCCT) recommended that for most patients with insulin-dependent DM, blood glucose levels should be as close to the nondiabetic r...

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
Vail D, Callaway NF, Ludwig CA, et al. Lipid-lowering mediations are associated with lower risk of retinopathy and ophthalmic interventions among U.S. patients with diabetes. Am J Ophthalm...

ADDITIONAL READING

  • Fassbender JM, Ozkok A, Canter H, et al. A comparison of immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy. Ophtha...

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

  • Schedule yearly ophthalmologic eye exams.

  • Options for the treatment of diabetic macular edema include focal laser treatment, intravitreal triamcinolone, intravitreal ranibizumab, intrav...

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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.
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...
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-...
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
Necrobiosis lipoidica diabeticorum. Atrophic patch present x 6 mo.
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