Advanced Proliferative Diabetic Retinopathy
Advanced PDR is not only characterized by retinal neovascularization and vitreous hemorrhage (VH) but also can include rubeosis iridis, neovascular glaucoma, and development of preretinal fibrous membranes with tractional retinal detachment (TRD), macular
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Advanced Proliferative Diabetic Retinopathy Neelakshi Bhagat and Marco Attilo Zarbin
Contents 5.1 5.2 5.3 5.4 5.5
Introduction ..................................................................................................................... Pathophysiology .............................................................................................................. Neovascular Glaucoma ................................................................................................... Tractional Retinal Detachment ....................................................................................... Treatment ........................................................................................................................ 5.5.1 Panretinal Laser Photocoagulation ..................................................................... 5.5.2 Pars Plana Vitrectomy and Endophotocoagulation ............................................ 5.5.3 Anti-VEGF Treatment ........................................................................................ 5.5.4 Silicone Oil Tamponade ..................................................................................... Conclusion ............................................................................................................................... References ................................................................................................................................
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N. Bhagat, MD, MPH, FACS Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Room 6156, Doctors Office Center Suite 6100, 90 Bergen Street, Newark, NJ 07103, USA e-mail: [email protected], [email protected] M.A. Zarbin, MD, PhD (*) Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Room 6156, Doctors Office Center Suite 6100, 90 Bergen Street, Newark, NJ 07103, USA Department of Ophthalmology, University Hospital, Room 6156, Doctors Office Center, 90 Bergen Street, Newark, NJ 07103, USA e-mail: [email protected], [email protected] F. Bandello et al. (eds.), Clinical Strategies in the Management of Diabetic Retinopathy, DOI 10.1007/978-3-642-54503-0_5, © Springer-Verlag Berlin Heidelberg 2014
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N. Bhagat and M.A. Zarbin
Introduction
Diabetic retinopathy (DR) is a chronic ocular complication of diabetes that is seen to some degree in virtually all diabetics. The rate of progression varies depending on the duration of the disease, glycemic control, hypertension, and genetics. Proliferative diabetic retinopathy (PDR) is diagnosed in the presence of retinal or disc neovascularization, a consequence of retinal ischemia. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) reported a 25-year cumulative progression prevalence of DR and PDR to be 83 and 42 %, respectively, in type I diabetics [1]. Overall, the rate of progression to PDR and severe vision loss has decreased in the last two decades, most likely due to improveme
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