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Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Frank RN: Etiologic mechanisms in diabetic retinopathy.  In Ryan SJ, ed: Retina, Schachat AP and Murphy RP, eds  vol. 2 Medical Retina,, St. Louis, 1994, Mosby, p. 1245-1246 Damien Luviano, MD, FACS
Frank RN: Etiologic mechanisms in diabetic retinopathy.  In Ryan SJ, ed: Retina, Schachat AP and Murphy RP, eds  vol. 2 Medical Retina,, St. Louis, 1994, Mosby, p. 1263 Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
Adverse Risk Factors 1.  Long duration of diabetes ,[object Object],[object Object],2.  Poor metabolic control 3.  Pregnancy 4.  Hypertension 5.  Renal disease 6.  Other ,[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
Preproliferative diabetic retinopathy Treatment  - not required but watch for proliferative disease ,[object Object],[object Object],[object Object],[object Object],[object Object],Signs Damien Luviano, MD, FACS
Proliferative diabetic retinopathy  ,[object Object],[object Object],Neovascularization Neovascularization of disc = NVD ,[object Object],[object Object],Neovascularization elsewhere = NVE Damien Luviano, MD, FACS
Indications for treatment of proliferative diabetic retinopathy NVD > 1/3 disc in area Less extensive NVD  +  haemorrhage NVE > 1/2 disc in area +  haemorrhage Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Laser panretinal photocoagulation  Damien Luviano, MD, FACS
Assessment after photocoagulation ,[object Object],[object Object],Poor involution ,[object Object],[object Object],[object Object],[object Object],Good involution ,[object Object],Damien Luviano, MD, FACS
Treatment of clinically significant  macular oedema ,[object Object],[object Object],[object Object],Focal treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],Grid treatment ,[object Object],[object Object],Damien Luviano, MD, FACS
Indications for vitreoretinal surgery Retinal detachment involving macula Severe persistent vitreous  haemorrhage Dense, persistent premacular  haemorrhage Progressive proliferation  despite laser therapy Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
[object Object],Damien Luviano, MD, FACS
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Diabetes and hga1c

Notas del editor

  1. Infections: pneumonia, flu, death Dental disease Almost one-third severe periodontal diseases Complications of pregnancy major birth defects excessively large babies Nervous system disease About 60% to 70% mild to severe forms of nervous system damage Amputations More than 60% of nontraumatic lower-limb amputations. In 2000-2001, about 82,000 lower-limb amputations on DM Heart disease and stroke leading cause of diabetes-related deaths. High blood pressure 73% of adults with diabetes have blood pressure
  2. Infections: pneumonia, flu, death Dental disease Almost one-third severe periodontal diseases Complications of pregnancy major birth defects excessively large babies Nervous system disease About 60% to 70% mild to severe forms of nervous system damage Amputations More than 60% of nontraumatic lower-limb amputations. In 2000-2001, about 82,000 lower-limb amputations on DM Heart disease and stroke leading cause of diabetes-related deaths. High blood pressure 73% of adults with diabetes have blood pressure
  3. Infections: pneumonia, flu, death Dental disease Almost one-third severe periodontal diseases Complications of pregnancy major birth defects excessively large babies Nervous system disease About 60% to 70% mild to severe forms of nervous system damage Amputations More than 60% of nontraumatic lower-limb amputations. In 2000-2001, about 82,000 lower-limb amputations on DM Heart disease and stroke leading cause of diabetes-related deaths. High blood pressure 73% of adults with diabetes have blood pressure
  4. Infections: pneumonia, flu, death Dental disease Almost one-third severe periodontal diseases Complications of pregnancy major birth defects excessively large babies Nervous system disease About 60% to 70% mild to severe forms of nervous system damage Amputations More than 60% of nontraumatic lower-limb amputations. In 2000-2001, about 82,000 lower-limb amputations on DM Heart disease and stroke leading cause of diabetes-related deaths. High blood pressure 73% of adults with diabetes have blood pressure
  5. Diabetes mellitus (DM) major medical problem throughout the world. Diabetes causes wide array of long-term systemic complications considerable impact the patient and the society
  6. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
  7. Familial clustering Mutation of aldose reductase gene Increased risk of nephropathy (Type I) Heesom, et al, 1997 Earlier onset of diabetic retinopathy (Type II) Ko, et al, 1995
  8. Opening of tight junctions between endothelial cells Endothelial cell fenestration RPE plasma membrane infoldings Endocytic vesicle transport
  9. Total prevalence of diabetes among people aged 20 years or older, United States, 2002 Age 20 years or older: 18.0 million; 8.7% of all people in this age group have diabetes. Age 60 years or older: 8.6 million; 18.3% of all people in this age group have diabetes. Men: 8.7 million; 8.7% of all men aged 20 years or older have diabetes. Women: 9.3 million; 8.7% of all women aged 20 years or older have diabetes.
  10. WESDR