Diabetic Retinopathy for USMLE Step 1 and USMLE Step 2
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- Опубліковано 27 лис 2016
- Handwritten Video Lecture on the pathophsyiology, symptoms and treatment of Diabetic Retinopathy for USMLE Step 1 and USMLE Step 2
PATHOPHYSIOLOGY OF DIABETIC RETINOPATHY
Hyperglycemia increases blood flow to the retina which damages blood vessels and become leaky causing macular edema.
Also production of Sorbitol from glucose by aldose reductase enzyme. This consumes NADPH, which increases oxidative stress. Glucose is osmotically active causing further edema.
Advanced Glycated Enzymes causes crosslinks in collagen and increase vessel permeability leading to cataracts. RAGE causes proinflammatory state in patients with diabetic retinopathy.
Neovascularization in the eye of diabetic retinopathy leads to hypoxia and thrombi. Tissue release VEGF and causes new vessel formation. New vessels are leaky and contribute to edema
In the non-proliferative Diabetic Retinopathy (NPDR) is the early stage of diabetic retinopathy. MIcrovascular disfunction leads to loss of pericytes and damaged endothelium leading to microaneurysms. Also basement membrane dysfunction leads to leakage of lipids and proteins leading to hard exudates. Intraretineal hemorrhages which shows as generalized hemorrhage. Nerve fiber infarcts in patients with diabetic retinopathy also occurs.
Proliferative Diabetic Retinopathy (PDR). Ischemia of the retinal tissue releases VEGF and causes neovascularization. Once ruptures it shows as flame shaped hemorrhages or blot hemorrhages. Vitreous hemorrhage may also occur in patients with diabetic retinopathy.
Fibrosis of diabetic retinopathy causes tractional retinal detachment which may lead to permanent vision loss.
Macular Edema can occur at any stage and is a common cause of vision loss in diabetic retinopathy.
FUNDOSCOPIC EXAM OF DIABETIC RETINOPATHY
Hemorrhage isolated around the vessels. Microaneurysms seen as dilation. Hard exudates seen as yellow. Cotton wool spots due to low blood flow. Tortous vessel show neovascularization in patients with Diabetic Retinopathy.
SYMPTOMS OF DIABETIC RETINOPATHY
Generally asymptomatic and symptoms depends on undelrying cause. Therefore screening for diabetic retinopathy is important.
Diabetes Mellitus type 1 screening begins 5 years after diagnosis then ever 2 years.
Diabetic Mellitus Type 2 screening begins at diagnosis and then continues every 2 years.
MANAGEMENT FOR DIABETIC RETINOPATHY
Glycemic control
Nonproliferative Diabetic Retinopathy does not require treatment.
Proliferative Diabetic Retinopathy - anti-VEGF and Photocoagulation.
If there is vitreous hemorrhage then perform vitrectomy.
Macular Edema requires treatment even if occurs in nonproliferative Diabetic Retinopathy.
Concise and informative 👌🏼👌🏼👌🏼👌🏼👌🏼👌🏼👌🏼
The video was amazing , super helpful , thank you
Thanks for the video. Its helped a lot. Very well explained and simple to understand.
Super super helpful!!! May god bless you and I wish you
good luck
great video, super easy to understand thanks!
An excellent informative explanation
Thank you sooooo much❤❤
Brilliant explanation! Thanks!
Very helpful, thanks
Brilliantly explained, many thanks
Hey.. Can you please make a video for retinal detachment.. Your videos are really helpful
Amazing video thanks a lot🙏🏼🙏🏼🙏🏼
Amazing video
An amazing video ❤
thank a lot dr mr beast
thank you
thank you , amazing explanation
thank u baby
Thankyou
Can you explain about hypertensive retinopathy too?
nice :))
thanxxxxxx
You said "Macula aka fovea" that is incorrect, the Macula is the circle you drew while the fovea is a part inside of the macula.
So would a patient with type 1 diabetes mellitus...if patient were to get hit in the eye and patient wasn’t provided timely medical attention for his eye can this cause the disease to speed up the process and cause early blindness ?????
Just a correction, cataracts are the leading cause of blindness worldwide
Cataracts may cause blindness, but diabetic retinopathy leads more ..in NPDR stage vision lost. (10% of the world population are suffers from Diabetic)
Cataracts cause REVERSIBLE blindness whereas DM causes IRREVERSIBLE
Most common cause of reversible blindness = cataract, followed by refractive error
Most common cause of irreversible blindness = glaucoma
Diabetic retinopathy is a distant fifth in cause of blindness overall, though notably is it the only cause of blindness that increased between 1990 and 2010 worldwide.
Flaxman et al. Global causes of blindness and distance vision impairment
1990-2020: a systematic review and meta-analysis. Lancet Glob Health.
Cataract and glaucoma can occur simultaneously with retinopathy. Diabetes also don't spare those areas
Thanks for the Video =)
You say the increased blood glucose 'for one reason or another' causes increased blood flow to the retina. What is the physiology behind this? why does high blood sugar have this affect on retinal circulation?
I also want to know this
A hypothesis is that chronic hyperglycemia causes loss of pericytes, which play a role in regulating vascular tone, and loss of endothelial cells promotes retinal hemodynamic changes . Alternatively, fluctuations in blood glucose levels known to acutely alter retinal blood flow are also thought to contribute to microvascular damage.
In diabetic nephropathy, microvascular weakness causes???
👌🙏❤️
This has been a challenging time, and I appreciate you so much Dr Igudia, you have created a life that I thought was lost, thank you so much for curing my type 2 Diabetes
cataract is the number one cause of blindness.
13:04
Why too fast😢😢😭😭
Nano-grade eye drops should be the last-ditch treatment for diabetic retinopathy.
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All glory belongs to God !