- Hb 13.1 g/dl
- WCC 5 109/l
- Platelets 290 109/l
- Sodium 138 mmol/l , Potassium 4.1 mmol/l
- Urea 9 mmol/l , Creatinine 138 μmol/l
- Glucose 8 mmol/l
- Cholesterol 5.8 mmol/l , Triglycerides 3.2 mmol/l
- 12-lead ECG Normal
- 24-hour urine protein 1g
On Fundoscopy there was background retinopathy and the picture is shown below:
Case Discussion:
Diabetic Retinopathy:
Diabetic retinopathy, which is also known as diabetic eye disease is a condition in which the small blood vessels in the retina are affected as a complication of diabetes. The blood vessels in the retina may become leaked , get blocked and eventually affect the sight and may even lead to blindness.
Physiology Of Retina: The retina is a thin layer of light sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images that we can see. The macula is a very small area at the center of the retina that is responsible for our pinpoint vision. The surrounding part of the retina is responsible for the peripheral vision.
Clinical features: Diabetic retinopathy often has no early warning signs. It usually affects both eyes and when it progresses , the patient may notice vision changes or loss which may is often difficult to reverse.
Diabetic retinopathy is usually described to have tow stages:
1. Background or Non- Proliferative diabetic retinopathy: (NPDR): It is the earliest stage and patients have no symptoms with a normal 20/20 vision. In this stage the damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Sometimes deposits of cholesterol or other fats from the blood also leak into the retina.
The only way to detect NPDR is a fundus photography.
The changes in the eye that occur in Background retinopathy include:
- Microaneurysms: small bulges in the blood vessels of retina that often leak fluid.
- Retinal Hemorrhages: tiny spots of leaked blood in the retina.
- Hard Exudates: deposits of cholesterol or other fats .
- Macular Edema: swelling or thickening of the macula
- Macular Ischemia; small blood vessels close leading to decreased or lack of blood supply to the macula.
2. Proliferative diabetic Retinopathy (PDR): In this second stage abnormal new blood vessels (neovascularization) form on the retina. These vessels are very fragile and can burst and bleed and blur the vision. PDR can severely affect both the central and peripheral vision. The changes include:
- Vitreous Hemorrhage: the delicate new blood vessels bleed into the vitreous, preventing light rays from reaching the retina. If the hemorrhage is small there may be dark floater int he visual filed but if it is large it might block out the complete visual field.
- Traction Retinal Detachment: Scar tissue from neovascularization shrinks, causing the retina to wrinkle and pull from its normal position. Vision loss occurs when the macula or large areas of retina are detached.
- Neovascular Glaucoma: Sometimes neovascularization also occurs in the iris, which may block the normal flow of fluid out of the eye. this leads to pressure build up within the eys, which if severe can damage the optic nerve.
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