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Retinopathy, Diabetic, Proliferative: Differential Diagnoses & Workup

Author: Abdhish R Bhavsar, MD, Adjunct Assistant Professor, Department of Ophthalmology, University of Minnesota Medical School; Director of Clinical Research, Retina Center, PA; Past Chair, Consulting Staff, Department of Ophthalmology, Phillips Eye Institute
Coauthor(s): Neal H Atebara, MD, Clinical Assistant Professor, Department of Surgery, Division of Ophthalmology, University of Hawaii School of Medicine; John H Drouilhet, MD, FACS, Clinical Professor, Department of Surgery, Section of Ophthalmology, University of Hawaii, John A Burns School of Medicine
Contributor Information and Disclosures

Updated: Oct 6, 2009

Differential Diagnoses

Branch Retinal Vein Occlusion
Retinopathy, Diabetic, Background
Central Retinal Vein Occlusion
Retinopathy, Hemoglobinopathies
Macroaneurysm
Retinopathy, Valsalva
Macular Edema, Diabetic
Terson Syndrome

Other Problems to Be Considered

Retinopathy, radiation

Workup

Laboratory Studies

  • The fasting glucose level and the hemoglobin A1c (HbA1c) level are important to control. If the HbA1c level is maintained in the 6-7% range for several years, then the progression of diabetic retinopathy is reduced substantially, according to the DCCT.

Imaging Studies

  • Fluorescein angiography is an invaluable adjunct in the diagnosis and treatment of diabetic retinopathy.
    • Microaneurysms would appear as pinpoint hyperfluorescence that does not enlarge but rather fades in the later phases of the test.
    • Blot and dot hemorrhages can be distinguished from microaneurysms in that they appear as hypofluorescent rather than hyperfluorescent.
    • Areas of nonperfusion appear as homogenous dark patches bordered by occluded blood vessels.
    • IRMA is evidenced by collateral vessels that do not leak, usually found in the borders of the nonperfused retina.
    • Neovascularization: Neovascular tufts leak dye because of their high permeability; they start as hyperfluorescent areas that increase in size and intensity in the later phases of the test.
An area of neovascularization that leaks fluoresc...

An area of neovascularization that leaks fluorescein on angiography.

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An area of neovascularization that leaks fluoresc...

An area of neovascularization that leaks fluorescein on angiography.


Other Tests

  • B-scan ultrasonography can be used to evaluate the status of the retina if the media is obstructed by vitreous hemorrhage.

More on Retinopathy, Diabetic, Proliferative

Overview: Retinopathy, Diabetic, Proliferative
Differential Diagnoses & Workup: Retinopathy, Diabetic, Proliferative
Treatment & Medication: Retinopathy, Diabetic, Proliferative
Follow-up: Retinopathy, Diabetic, Proliferative
Multimedia: Retinopathy, Diabetic, Proliferative
References
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References

  1. Federman JL, Gouras P, Schubert H, et al. Systemic diseases. In: Podos SM, Yanoff M, eds. Retina and Vitreous: Textbook of Ophthalmology. Vol 9. 1994:7-24.

  2. Aiello LM, Cavallerano JD, Aiello LP, Bursell SE. Diabetic retinopathy. In: Guyer DR, Yannuzzi LA, Chang S, et al, eds. Retina Vitreous Macula. Vol 2. 1999:316-44.

  3. Benson WE, Tasman W, Duane TD. Diabetes mellitus and the eye. In: Duane's Clinical Ophthalmology. Vol 3. 1994.

  4. Frank RN. Etiologic mechanisms in diabetic retinopathy. In: Ryan SJ, ed. Retina. 1994:1243-76.

  5. Praidou A, Klangas I, Papakonstantinou E, Androudi S, Georgiadis N, Karakiulakis G, et al. Vitreous and Serum Levels of Platelet-Derived Growth Factor and Their Correlation in Patients with Proliferative Diabetic Retinopathy. Curr Eye Res. Feb 2009;34(2):152-161. [Medline].

  6. Merlak M, Kovacevic D, Balog T, Marotti T, Misljenovic T, Mikulicic M, et al. Expression of vascular endothelial growth factor in proliferative diabetic retinopathy. Coll Antropol. Oct 2008;32 Suppl 2:39-43. [Medline].

  7. Davis MD. Proliferative diabetic retinopathy. In: Ryan SJ, ed. Retina. Vol 2. 1994:1319-60.

  8. Akduman L, Olk RJ. The early treatment for diabetic retinopathy study. In: Kertes C, ed. Clinical Trials in Ophthalmology: A Summary and Practice Guide. 1998:15-36.

  9. Bhavsar AR, Grillone LR, McNamara TR, Gow JA, Hochberg AM, Pearson RK. Predicting response of vitreous hemorrhage after intravitreous injection of highly purified ovine hyaluronidase (Vitrase) in patients with diabetes. Invest Ophthalmol Vis Sci. Oct 2008;49(10):4219-25. [Medline].

  10. Arevalo JF, Garcia-Amaris RA. Intravitreal bevacizumab for diabetic retinopathy. Curr Diabetes Rev. Feb 2009;5(1):39-46. [Medline].

  11. Rodriguez-Fontal M, Alfaro V, Kerrison JB, Jablon EP. Ranibizumab for diabetic retinopathy. Curr Diabetes Rev. Feb 2009;5(1):47-51. [Medline].

  12. Quillen DA, Gardner TW, Blankenship GW. The diabetic retinopathy study. In: Kertes C, ed. Clinical Trials in Ophthalmology: A Summary and Practice Guide. 1998:1-14.

  13. Bhavsar AR. Diabetic retinopathy: the latest in current management. Retina. Jul-Aug 2006;26(6 Suppl):S71-9. [Medline].

  14. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. September 2008;115 (9):1447-1449. [Medline].

  15. Meredith TA. The diabetic vitrectomy study. In: Kertes C, ed. Clinical Trials in Ophthalmology-A Summary and Practice Guide. 1998: 37-48.

  16. Genuth S. The UKPDS and its global impact. Diabet Med. Aug 2008;25 Suppl 2:57-62. [Medline].

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Further Reading

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Keywords

proliferative diabetic retinopathy, PDR, diabetic retinopathy treatment, macular edema, neovascularization, optic disc, optic disk, NVD, neovascularization elsewhere, NVE, background diabetic retinopathy, nonproliferative diabetic retinopathy, NPDR, diabetes mellitus, DM, diabetes mellitus retinopathy, DM retinopathy, blindness, vision loss, visual acuity loss, visual loss, tractional retinal detachment, vitreous hemorrhage

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Contributor Information and Disclosures

Author

Abdhish R Bhavsar, MD, Adjunct Assistant Professor, Department of Ophthalmology, University of Minnesota Medical School; Director of Clinical Research, Retina Center, PA; Past Chair, Consulting Staff, Department of Ophthalmology, Phillips Eye Institute
Abdhish R Bhavsar, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Minnesota Medical Association
Disclosure: Allergan Grant/research funds None; genentech Grant/research funds None; regeneron Grant/research funds None; sirion Grant/research funds None

Coauthor(s)

Neal H Atebara, MD, Clinical Assistant Professor, Department of Surgery, Division of Ophthalmology, University of Hawaii School of Medicine
Neal H Atebara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Hawaii Medical Association, and Retina Society
Disclosure: Nothing to disclose.

John H Drouilhet, MD, FACS, Clinical Professor, Department of Surgery, Section of Ophthalmology, University of Hawaii, John A Burns School of Medicine
John H Drouilhet, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

V Al Pakalnis, MD, PhD, Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center
V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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