Diabetic Retinopathy

Alexander Brucker, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

George L. Mayo, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Ali A. Zaidi, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

The Planners of this activity have no relationships to disclose.

Alexander Brucker, MD, is professor of ophthalmology at the University of Pennsylvania, and chief, Retina-Vitreous Services at Philadelphia's Scheie Eye Institute. George L. Mayo, MD, is a clinical instructor at the Scheie Eye Institute and a fellow in vitreoretinal surgery at the University of Pennsylvania School of Medicine. Here, they define diabetic retinopathy, describe the retina and its function, and discuss diagnosis, and treatment of this leading cause of blindness in the age group 20-74. Ali A. Zaidi, MD is a Fellow in Vitreoretinal Surgery at the Scheie Eye Institute of the University of Pennsylvania. He completed an Ophthalmology Residency at the University of Pennsylvania School of Medicine and completed Medical School at University of California, San Francisco (UCSF).

This lecture and the post-test is worth 1.5 credit hours.

The authors describe through text, retinal photos and illustrations the various stages of diabetic retinopathy and their manifestations, noting that the earliest change is a decrease in the number of intramural pericytes within the retinal capillaries. Pathophysiology of diabetic retinopathy has focused on phosphorylating enzyme protein kinase C and vascular endothelial growth factor, whose levels are increased in patients with proliferative diabetic retinopathy (PDR).

The lecture provides information on several clinical trials in diabetic retinopathy, including the Diabetic Retinopathy Study which found that laser surgery is the most effective form of treatment. And, according to the Early Treatment of Diabetic Retinopathy Study, patients with clinically significant macular edema benefited from focal laser treatment. Other national collaborative studies and their findings include the Diabetic Retinopathy Vitrectomy Study, the Protein Kinase C Inhibition Study and the Diabetes Control and Complications Trial which showed the benefits of strict metabolic control in diabetics reduced the risk of progressing to diabetic retinopathy by 76%.

The authors reiterate that laser surgery for diabetic retinopathy is the only proven form of treatment at present, with experimental treatments including off-label use of intraocular steroids. The lecture concludes with a discussion of Pars Plana Vitrectomy, the removal of the vitreous from the inside of the eye.