oftalmologia: "retinopatia diabetica"
TRANSCRIPT
![Page 1: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/1.jpg)
RETINOPATIA DIABETICA.
Hospital Regional de Alta Especialidad
ciudad salud
DRA. VERONICA BECERRA CAMEY.
Servicio de OftalmologíaRETINOPATIA DIABETICA
SERVICIO DE OFTALMOLOGIA - Retina
HRAE “Ciudad Salud”
![Page 2: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/2.jpg)
RETINOPATIA DIABETICA
Es una microangiopatía que afecta a arteriolas
precapilares, capilares y vénulas de la retina y que
pertenece al grupo de las retinopatías hipóxicas.
La diabetes puede ser insulinodependiente (DM1) o no
insulinodependiente (DM2).
La prevalencia de la retinopatía diabética (RD) es mayor
en la diabetes mellitus tipo I (40%) que en la tipo 2
(20%).
La RD es la causa más frecuente de ceguera legal en
las personas entre los 20 y los 65 años de edad.
![Page 3: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/3.jpg)
ETIOPATOGENIA.
VEGF: Factor de crecimiento
endotelial vascular.
![Page 4: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/4.jpg)
![Page 5: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/5.jpg)
![Page 6: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/6.jpg)
FACTORES DE RIESGO.
Tiempo de evolución.
Valores de glucosa.
Embarazo.
Enf. Renal.
Hipertensión.(RDP)
Otros (Tabaquismo, obesidad, hiperlipidemia).
![Page 7: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/7.jpg)
FACTOR DE RIESGO
TIEMPO DE EVOLUCION (ETDRS).
Tiempo de
evolución.
Retinopatía
5 años no
10 años 71%
30 años 90%
30% RDP o
complicada
![Page 8: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/8.jpg)
CLASIFICACION
I.- Retinopatía diabética de base.
Leve
II.- Retinopatía diabética preproliferativa.
Moderada
III.- Retinopatía diabética proliferativa.
Severa
Con o sin características de alto riesgo.
Con o sin edema macular.
![Page 9: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/9.jpg)
RETINOPATIA DIABETICA DE BASE.
![Page 10: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/10.jpg)
![Page 11: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/11.jpg)
![Page 12: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/12.jpg)
RETINOPATIA DIABETICA PREPROLIFERATIVA
![Page 13: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/13.jpg)
![Page 14: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/14.jpg)
![Page 15: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/15.jpg)
![Page 16: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/16.jpg)
RETINOPATIA DIABETICA PROLIFERATIVA.
![Page 17: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/17.jpg)
![Page 18: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/18.jpg)
![Page 19: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/19.jpg)
Hemorragia prerretiniana
(subhialoidea).
![Page 20: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/20.jpg)
Hemorragia vítrea
FACTOR DE RIESGO DE PERDIDA VISUAL IMPORTANTE.
![Page 21: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/21.jpg)
Proliferación fibrovascular > Riesgo de desprendimiento
de retina traccional.
![Page 22: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/22.jpg)
RETINOPATIA DIABETICA PROLIFERATIVA
AVANZADA-Desprendimiento de retina traccional
![Page 23: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/23.jpg)
Glaucoma Neo vascular.
![Page 24: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/24.jpg)
FLUORANGIOGRAFIA
![Page 25: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/25.jpg)
CLASIFICACION ANGIOGRAFICA
edema macular focalizado
![Page 26: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/26.jpg)
Edema macular multifocal.
![Page 27: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/27.jpg)
Edema macular difuso.
![Page 28: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/28.jpg)
Edema macular isquémico
![Page 29: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/29.jpg)
Edema Macular Cistoide
![Page 30: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/30.jpg)
![Page 31: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/31.jpg)
DIAGNOSTICO
Clínico
Fluorangiografía
Tomografía de coherencia óptica (OCT)
USG modo B
![Page 32: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/32.jpg)
![Page 33: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/33.jpg)
TOMOGRAFIA DE COHERENCIA OPTICA (OCT)
![Page 34: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/34.jpg)
ULTRASONIDO MODO B
![Page 35: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/35.jpg)
TRATAMIENTO
1968
LASER
1992 VITRECTOMIA
2005
ANTI-VEGF
2000TERÁPIA
FOTODINAMICA
![Page 36: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/36.jpg)
FOTOCOAGULACION CON LASER
↓
Destruye la retina hipoxica.
↓
Permite el aumento de la difusión de oxigeno desde la
coroides.
↓
Disminuye el factor vasoproliferativo.
![Page 37: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/37.jpg)
QUEMADURA.
Marcas Blanca - grisáceas.
↑ blancas- mucha intensidad
↓ grises- poca intensidad.
![Page 38: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/38.jpg)
![Page 39: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/39.jpg)
MEDICAMENTOS
INTRAVITREOS
![Page 40: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/40.jpg)
Vía pars plana
![Page 41: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/41.jpg)
![Page 42: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/42.jpg)
Edema macular difuso
![Page 43: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/43.jpg)
COMPLICACIONES
4% enrojecimiento en el sitio de aplicación
Hemorragia sub conjuntival
Uveítis anterior 1.5%
Incidencia de endoftalmitis post inyección
0.02% (1/ 4,500)
HTA/EVC
![Page 44: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/44.jpg)
TRACCION VITREA.
Cuando se asocian edema macular con
tracción tangencial por una membrana
hialina posterior engrosada y tensa .
![Page 45: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/45.jpg)
VITRECTOMIA
![Page 46: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/46.jpg)
PREVIA VITRECTOMIA
POST VITRECTOMIA
VITRECTOMIA
![Page 47: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/47.jpg)
COMPLICACIONES EN LA VITRECTOMIA
Catarata 30%
Desprendimiento de retina regmatógeno 10%
Endoftalmitis 0.051%
![Page 48: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/48.jpg)
Early Treatment Diabetic Retinopathy Study
(ETDRS)
Anormalidad Retinal Seguimiento Sugerido
Normal o RDNP leve Anual
RDNP moderada Cada 9 meses
RDNP severa Cada 4 meses
EMCS Cada 2 a 4 meses
RDP Cada 2 a 3 meses
![Page 49: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/49.jpg)
![Page 50: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/50.jpg)
![Page 51: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/51.jpg)
![Page 52: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/52.jpg)
![Page 53: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/53.jpg)
![Page 54: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/54.jpg)
![Page 55: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/55.jpg)
![Page 56: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/56.jpg)
REVISION DEL PACIENTE POSTERIOR A
TRATAMIENTO CON LASER
Citas
- Dependiendo la estabilidad de la retinopatía se
seguirá el control
FAG de control
- A los 3 meses de tratamiento.
- anual.
![Page 57: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/57.jpg)
TRATAMIENTO.
INSULINA.
Prevalencia de retinopatía diabética 64%.
HIPOGLUCEMIANTES.
Prevalencia de retinopatía diabética 36%.
DIETA.
Prevalencia de retinopatía diabética 12%.
![Page 58: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/58.jpg)
CONTROL METABOLICO.
Valores elevados de glicemia.
> 200mg/dl.
Hemoglobina glicosilada.
![Page 59: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/59.jpg)
Bevacizumab
(Avastin)
Ranibizumab
(Lucentis)
Pegaptanib
(Macugen)
![Page 60: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/60.jpg)
RETINOPATIA DIABETICA CON EDEMA
MACULAR.
![Page 61: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/61.jpg)
RETINOPATIA DIABETICA CON EDEMA
MACULAR DIFUSO.
![Page 62: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/62.jpg)
ETIOPATOGENIA.
Hiperglucemia ↑ sorbitol
↑ factores de coagulación VIII.
↓ deformabilidad del eritrocito.
↑ agregación plaquetaria.
![Page 63: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/63.jpg)
¿DONDE?
Extra macular:
- panfotocoagulación.
cerrada.
- tratamiento focal.
Mácula:
- focal.
- multifocal.
- rejilla.
![Page 64: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/64.jpg)
![Page 65: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/65.jpg)
TIPOS DE LASER.
Láser argón.
Longitud de onda verde (488nm) (514nm)
absorbe melanina y hemoglobina.
Láser Kriptón.
Longitud de onda del láser rojo (647nm)
absorbe melanina.
Láser diódo.
Longitud de onda roja (810nm)
![Page 66: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/66.jpg)
Tamaño de la quemadura.
- Mácula 100 micras
- Polo posterior y ecuador 150- 200 micras
- Periferia 400 a 500 micras
Tiempo
- Área macular 0.1 seg. o 100 milisegundos
- Extra macular 0.2 seg. o 200 milisegundos.
Poder
- Área macular 90-100 mili watts
- Área extra macular 200 mili watts (variable)
![Page 67: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/67.jpg)
COMPLICACIONES POSTERIOR A
TRATAMIENTO CON LASER.
Retardo de adaptación a la oscuridad.
Pérdida de 2 líneas de visión.
Fotofobia.
Alteración en el campo visual.
![Page 68: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/68.jpg)
Rubeosis ( 48 hrs ) regresión
Recurrencia (2 meses)
Angulo cerrado
control en 7%
Angulo abierto
Control 71 %
Tratamiento coadyuvante a la fotocoagulación.
![Page 69: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/69.jpg)
¿CUANTO Y DONDE APLICAR LASER?
![Page 70: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/70.jpg)
¿CUANDO INICIAR TRATAMIENTO CON
LASER?.
Retinopatía diabética leve - Láser
Retinopatía diabética moderada - Láser
Retinopatía diabética severa - Láser
![Page 71: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/71.jpg)
Aplicación de Anti-VEGF
Contracción del vítreo
DR traccional
![Page 72: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/72.jpg)
OBJETIVO DELTRATAMIENTO.
Preservar la visión del paciente.
Mejorar la oxigenación.
- Tratando zonas de isquemia.
- Tratando zonas de edema (fuga).
![Page 73: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/73.jpg)
![Page 74: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/74.jpg)
Retinopatía proliferativa:
![Page 75: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/75.jpg)
![Page 76: OFTALMOLOGIA: "Retinopatia Diabetica"](https://reader033.vdocuments.net/reader033/viewer/2022061518/55ada4561a28ab280c8b46fb/html5/thumbnails/76.jpg)
CONCLUSIONES.
El manejo multidisciplinario y la labor del
paciente son capaces de asegurar en la
mayoría de los casos, la preservación de la
visión a lo largo de la enfermedad.