糖尿病視網膜病變

糖尿病視網膜病變

視力模糊 ,

眼前黑影

,

畏光

,

流淚

What ’ s your suggestion ?

糖尿病眼病變 Keratopathy 角膜 Cataract 白內障 Glaucoma 青光眼 Retinopathy 視網膜

Symptpms Painless white eye/ painful red eye 紅眼 Decrease of central vision / total visual loss 力不良 Floater, metamrophopsia, photopsia 視 飛蚊 閃光

Examinations

檢查

Visual acuity 視力 Biomicroscope ( slit lamp) Fundus direct ophthalmoloscope indirect ophthalmoloscope Ultrasonography Fluorescein angiography ( FAG )

螢光眼底血管攝影檢查

Diabetic retinopathy

糖尿病視 網膜病變

Background diabetic retinopathy ( BDR ) Preproliferative diabetic retinopathy ( PPDR ) Proliferative diabetic retinopathy ( PDR ) Clinical significant macular edema ( CSME )

Vessel occlusion and Microaneurysm

Hard exudate

Background diabetic retinopathy (BDR) Microaneurysm Hemorrhages Hard exudate Retinal edema

Preproliferative diabetic retinopathy ( PPDR ) Vascular change ( beading, looping, sausage-like ) Cotton-wool spots Intraretinal microvascular abnormalities

4-2-1 rule for panretinal photocoagulation Microaneurysm or hemorrhage (4 quadrants) Venous beading (2 quadrants) Intraretinal microvascular abnormalities (1 quadrant) ETDRS ophthalmomogy. 1991

PDR

Proliferative diabetic retinopathy ( PDR ) Retinal neovasculization Vitreous hemorrhage Tractional retinal detachment

Clinical significant macular edema ( CSME )

Laser photocoagulation

視網膜光凝固鐳射治療

1. Clinical significant macular edema ( CSME )  Focal retinal photocoagulation ( FRP ) 2. Neovascularization or severe PPDR  Panretinal photocoagulation ( PRP ) ophthalmomogy. 1995

雷射

視網膜光凝固鐳射治療

Surgery

手術   Intravitreal injection of steroid For clinical significant macular edema ( CSME ) ophthalmomogy. 2003 Pars plana vitrectomy for vitreous hemorrhage and tractional retinal detachment ophthalmomogy. 1998

Intravitreal injection of steroid

眼內注射藥物

For clinical significant macular edema ( CSME ) Elevated intraocular pressure Cataract

Follow up schedule

追蹤

Message to take back

記住

Always follow up regularly 定期追蹤 Early diagnosis and early treatment 早期診斷早期治療

Thank you