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Diabetes: Proliferative retinopathy assessment

Disease
The hallmark of proliferative diabetic retinopathy (PDR) is neovascularisation. Retinal ischaemia is thought to play a major role in this process. New vessels originate as endothelial proliferations, which pass through defects in the internal limiting membrane of the retina and become attached to the posterior vitreous cortex.

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Complications of PDR can cause sudden and severe loss of vision. Less catastrophic haemorrhage or retinal detachment can produce floaters, blots or flashing lights in the visual field. Patients may experience ocular pain, photophobia and decreased vision with neovascular glaucoma.

Signs

Significantly, visual acuity may be normal in the presence of vision-threatening PDR.

When complications occur, acuity may be reduced to hand movements or worse. The iris is examined for new vessels in the iris (NVI) and neovascular glaucoma prior to dilation. (The pupils of diabetic patients often have a slow or poor response to mydriatics.) In diabetic patients, PDR is defined as one or more of:

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