Diabetic retinopathy (DR) is

essentially, but not exclusively, a

microvascular disease.

 Diabetic retinopathy progresses from mild

nonproliferative abnormalities,
characterized by increased vascular
permeability, to moderate and severe
nonproliferative diabetic retinopathy
(NPDR), characterized by vascular closure,
to proliferative diabetic retinopathy
(PDR), characterized by the growth of
new blood vessels on the retina and
posterior surface of the vitreous.

 Macular edema, characterized by

retinal thickening from leaky blood
vessels, can develop at all stages of
retinopathy.

Faktor risiko
Diabetic retinopathy (DR) is
commoner in type] (40%) than in
type 2 (20%). and is the most
prevalent cause of legal blindness
between the ages of 20 and 65
years.

Obj.
Diabetic retinopathy (DR) may be defined as the
presence of typical retinal microvascular lesions in
an individual with diabetes.
Microaneurysms (Ma),
haemorrhages,
hard exudates (HEx),
cotton wool spots (CWS),
intraretinal microvascular abnormalities (IRMA),
venous beading (VB),
new vessels and
fibrous tissue

comprise the clinical features of DR.

?
Macular drusen are bilateral.
focal yellow spots which may be
mistaken for hard exudates.
However, they are not arranged in
clumps or rings and arc not
associated with retinal microvascular
changes.
DD dari retinopati diabetik

 Blindness

Pocket of Atlas
Opthalmology

 Diabetic retinopathy is classified

according to the presence or absence
of abnormal new vessels as:
Non-proliferative
(background/preproliferative)
retinopathy
Proliferative retinopathy
Each has a different prognosis for
vision.

Klasifikasi Retinopati Diabetik

AK. Khurana,
Comprehensive
Opthalmology 4th ed.

T. Schlote, et al.,
Pocket of Atlas
Opthalmology, 2006

In terms of both prognosis and

treatment, it is useful to divide
diabetic retinopathy into
nonproliferative and proliferative
categories.
Vaughan & Ashburys
Gen. Opthal., 16th ed.

The Royal College of

Opthalmologists,Diabe
tic Retinopathy
Guidelines 2012

Guidelines for the

Management of Diabetic
Retinopathy, National
Health and Medical
Research Council
(NHMRC) Australian
Govt., 2008

The Royal College of

Opthalmologists,Diabe
tic Retinopathy
Guidelines 2012

NPDR
DR is first evident ophthalmoscopically as nonproliferative (previously termed background)
retinopathy (NPDR), which may evolve to
proliferative retinopathy (PDR).
Typical early NPDR lesions include
microaneurysms (Ma) and dot, blot or flame
haemorrhages (H/Ma).
More advanced NPDR lesions include hard
exudates (Hex), cotton wool spots (CWS) or
soft exudates, intraretinal microvascular
abnormalities (IRMA) and venous beading (VB).
Guidelines for the Management of Diabetic
Retinopathy, National Health and Medical
Research Council (NHMRC) Australian Govt., 2008

PDR
Proliferative diabetic retinopathy (PDR) is
characterised by growth of abnormal new
vessels and fibrous tissue in response to
retinal ischaemia, and the subsequent
development of pre-retinal or vitreous
haemorrhage, or fibrous proliferation.
If new vessels appear on or within one disc
diameter of the disc margin, they are known as
new vessels on the disc (NVD). In other
locations, they are referred to as new vessels
elsewhere (NVE).

 High-risk characteristics (HRC) of PDR,

signifying a poor visual prognosis,
are:
(1) NVD disc area in extent, or
(2) any NVD with vitreous or pre-retinal
haemorrhage, or
(3) NVE disc area in extent associated
with vitreous or pre-retinal haemorrhage, or
(4) vitreous or pre-retinal haemorrhage
obscuring 1 disc area.

ME
Capillary leak in the macular or
perimacular region results in retinal
thickening or diabetic macular edema
(oedema)/(DME), defined as thickening
located within two disc diameters of the
centre of the macula. When this is
present within or close to the central
macula, it is termed clinically significant
macular oedema (CSME)