Proliferative diabetic retinopathy occurs in 5% of all diabetics. Younger-onset diabetics have an increased risk of the disease after 30 years. Until recently 50-70% of cases of proliferative diabetic retinopathy became blind within five years.
Proliferative diabetic retinopathy is characterised by the development of new blood vessels (neovascularisation) on the optic nerve head or the retina (Figure 21.4). These occur as a response to retinal ischaemia. These new vessels can appear as small tufts, which ramify irregularly. They might be flat initially but enlarge and move forward into the vitreous cavity as they grow. Once the new vessels form and grow, there is increased risk of an acute pre retinal or vitreous haemorrhage. This is a significant threat to vision because the vitreous haemorrhages can become recurrent or dense, preventing any meaningful examination and treatment. Retinal fibrosis, traction retinal detachment and neovascular glaucoma can occur at a later stage.
It is important to appreciate that proliferative retinopathy can be quite severe before the patient notices anything and the situation might have to be explained carefully to him or her.
Figure 21.4. Proliferative diabetic retinopathy.EQ
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