Diabetic retinopathy: an update

Abstract

Diabetes mellitus is a major cause of avoidable blindness in both the developing and the developed countries. Significant technological advances have taken place to improve the diagnostic accuracy of diabetic retinopathy. In the last three decades, the treatment strategies have been revised to include, besides laser photocoagulation, early surgical interventions and pharmacotherapies.

Figure 1

Case 1: Fundus photograph of the right eye showing massive peripapillary fibrovascular proliferation with vitreous hemorrhage

Figure 2

Case 1: Fundus photograph of the same eye after pars plana vitreous surgery

Figure 3

Case 2: Fundus photograph of the right eye shows severe non-proliferative diabetic retinopathy with macular edema and hard exudates threatening the foveal center

Figure 4

Case 2: Optical coherence tomography line scan shows retinal thickening with spongy retina and cystoid changes in the center along with subfoveal serous detachment

Figure 5

Case 2: Patient underwent grid laser photocoagulation 2 weeks after receiving 40-mg subtenon triamcinolone injection. Three months post-laser treatment, fundus photograph of the same eye shows severe non-proliferative diabetic retinopathy without significant macular edema

Figure 6

Case 2: Three months post-laser treatment, optical coherence tomography line scan shows mild retinal thickening with spongy retina

Figure 7

Case 3: Fundus photograph of the right eye shows severe non-proliferative diabetic retinopathy with macular edema (a). Late phase of angiogram shows early microaneurysmal leakage with diffuse late leakage with cystoid changes (b). Optical coherence tomography line scan shows retinal thickening with spongy retina with cystoid changes in the center (c)

Figure 8

Case 3: Fundus photograph of the same eye six weeks after receiving 1.25 mg/0.05 ml intravitreal Avastin shows decreased macular edema (a). Late phase of angiogram shows reduction in diffuse leakage 6 weeks after Avastin (b). Optical coherence tomography line scan shows marked reduction in retinal thickening and restoration of foveal contour at 6 weeks after Avastin (c)

Figure 9

Case 3: Ten weeks after Avastin, fundus photograph of the same eye shows reappearance of macular edema (a). Late phase of angiogram shows reappearance of diffuse leakage at 10 weeks after Avastin (b). Optical coherence tomography line scan at 10 weeks after Avastin shows increase in retinal thickening, showing that the effect of anti-VEGF drugs Avastin is transient (c)