Advanced Diabetic Eye Disease

-End-stage vision-threatening complication of diabetic retinopathy in patients whose treatment is inadequate or unsuccessful

-It may present as pre-retinal or intragel hemorrhage, tractional retinal detachment, or rubeosis iridis

1) HAEMORRHAGE:

-May be preretinal (retrohyaloid), intragel or both.

-Intragel haemorrhages usually take longer to clear than preretinal because the former is usually more sub-stantial

-In some eyes, altered blood becomes compacted on the posterior vitreous face to form an ochre membrane

-Ultrasonography is used in eyes with dense vitreous haemorrhage to detect the possibility of associated retinal detachment

2) TRACTIONAL RETINAL DETACHMENT:

-Caused by progressive contraction of fibrovascular membranes over areas of vitreoretinal attachment

-Posterior vitreous detachment in eyes with PDR is often incomplete due to the strong adhesions between cortical vitreous and areas of fibrovascular proliferation

Haemorrhage often occurs at these sites due to stress exerted on NV

3) RUBEOSIS IRIDIS:

-Iris neovascularization (NVI) may occur in eyes with PDR and if severe may lead to neovascular glaucoma

-NVI is particularly common in eyes with severe retinal ischemia or persistent RD following unsuccessful pars plana vitrectomy

TREATMENT

- PRP

- Pars plana vitrectomy + Endolaser

Image from Rajan Eye Care Hospital

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