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Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001

.pdf

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28.03.2026

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<<< < Предыдущая 53 54 55 56 57 58 59 60 61 62 63 6465 / 8765 66 67 68 69 70 71 72 73 74 75 76 77 > Следующая >>>

Ischaemic diabetic maculopathy


•	Macula appears relatively normal	•	Capillary non-perfusion on FA
•	Poor visual acuity	•	Treatment not appropriate

Clinically significant macular oedema

Retinal oedema within 500 m

of centre of fovea

Hard exudates within 500 m of centre of

fovea with adjacent oedema which may be outside 500 m limit

Retinal oedema one disc area or larger any part of which is within one disc diameter (1500 m) of centre of fovea

Treatment of clinically significant macular oedema

Grid treatment

Focal treatment

•	For diffuse retinal thickening located more •		For microaneurysms in centre of hard
	than 500 m from centre of fovea and		exudate rings located 500-3000 m
	500 m from temporal margin of disc		from centre of fovea
•	Gentle burns (100-200 m, 0.10 sec),	•	Gentle whitening or darkening of
•	Gentle burns (100-200 m, 0.10 sec),		microaneurysm (100-200 m, 0.10 sec)
	one burn width apart		microaneurysm (100-200 m, 0.10 sec)

Preproliferative diabetic retinopathy

Signs


•	Cotton-wool spots	•	Dark blot haemorrhages
•	Venous irregularities	•	Intraretinal microvascular
			abnormalities (IRMA)

Treatment - not required but watch for proliferative disease

Proliferative diabetic retinopathy

•Affects 5-10% of diabetics

•IDD at increased risk (60% after 30 years)

Neovascularization

•Flat or elevated

•Severity determined by comparing with area of disc

Neovascularization of disc = NVD Neovascularization elsewhere = NVE

Indications for treatment of proliferative diabetic retinopathy


NVD > 1/3 disc in area	Less extensive NVD	NVE > 1/2 disc in area
	+ haemorrhage	+ haemorrhage

Laser panretinal photocoagulation


• Initial treatment is 2000-3000 burns	• Area covered by complete PRP
• Spot size (200-500 m) depends	• Follow-up 4 to 8 weeks
on contact lens magnification
• Gentle intensity burn (0.10-0.05 sec)

Assessment after photocoagulation

Poor involution

Good involution

•	Persistent neovascularization	•	Regression of neovascularization
•	Haemorrhage	•	Residual ‘ghost’ vessels or
			fibrous tissue
•	Re-treatment required	•	Disc pallor
		•	Disc pallor

Indications for vitreoretinal surgery


Severe persistent vitreous	Dense, persistent premacular
haemorrhage	haemorrhage


Progressive proliferation	Retinal detachment involving
despite laser therapy	macula

OTHER RETINAL VASCULAR DISORDERS

1.Retinal vein occlusion

•Branch

•Central

2.Retinal artery occlusion

•Branch

•Cilioretinal

•Central

3.Hypertensive retinopathy

4.Sickle-cell retinopathy

5.Retinopathy of prematurity

6.Retinal telangiectasias

•Idiopathic juxtafoveolar

•Leber miliary aneurysms

•Coats disease

7.Retinal artery macroaneurysm

8.Radiation retinopathy

<<< < Предыдущая 53 54 55 56 57 58 59 60 61 62 63 6465 / 8765 66 67 68 69 70 71 72 73 74 75 76 77 > Следующая >>>

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