Pdr (proliferative Diabetic Retinopathy)

Clinical Description

PDR is the more advanced stage of diabetic retinopathy characterised by retinal neovascularization i.e., growth of fragile new blood vessels on the retina. The new vessels often bleed into the vitreous and can form fibrous tissue that results in a tractional pull on the retina.

Signs and Symptoms

Symptoms of diabetic retinopathy:

• Changes in vision
• Blurry vision or intermittent changes from blurry to clear
• blank or dark areas in the field of vision
• poor night vision, and
• faded or washed-out colors
• visual loss.
• Floaters

Treatment

Management of PDR

• Pan retinal photocoagulation with argon laser
• consider Intravitreal Anti Vascular endothelial growth factors (Anti VEGFs) eg

Bevacizumab, Ranibizumab, Aflibercept

• Vitrectomy for PDR with tractional retinal detachment

Management of Clinically Significant Macular Oedema

• Focal/grid macular laser
• Intravitreal Anti VEGFs (eg Bevacizumab, Ranibizumab, Aflibercept) once monthly for 4 months or more depending on response

Complications and Referral Criteria

• Refer to a tertiary facility when fundoscopy shows any of the following:
• Severe NPDR
• Presence of hemorrhages in four quadrants of the retina or if there is venous beading in two quadrants or if there are intraretinal microvascular abnormalities in one quadrant of the retina.
• PDR
• Presence of features such as new vessels or fibrosis on the retina, vitreous hemorrhage, preretinal hemorrhage or tractional retinal detachment
• Clinically significant macular oedema (CSMO) o retinal thickening at or within 500 μm of the center of the macula.

o hard exudates at or within 500 μm of the center of the macula, if associated with adjacent retinal thickening; or a zone or zones of retinal thickening one disc area in size, at least part of which is within one disc diameter of the center of the macula