Proliferative Diabetic Retinopathy (PDR)
Ophthalmology: Advanced Microvascular Complications
1. Pathophysiology
PDR is driven by chronic hyperglycemia, leading to retinal ischemia. This triggers the release of angiogenic factors, primarily Vascular Endothelial Growth Factor (VEGF), which causes the hallmark development of abnormal new blood vessels.
2. Clinical Key Findings
| Feature | Clinical Significance |
|---|---|
| Neovascularization (NV) | New, fragile vessels (NVD at disc, NVE elsewhere); prone to rupture. |
| Vitreous Hemorrhage | Sudden painless vision loss due to rupture of fragile new vessels. |
| Tractional Detachment | Fibrous tissue associated with NV shrinks, pulling the retina away from the pigment epithelium. |
3. Management & High-Yield Pearls
- Pan-Retinal Photocoagulation (PRP): The definitive laser treatment to destroy ischemic retina and reduce VEGF production.
- Anti-VEGF Therapy: Intravitreal injections (e.g., ranibizumab, aflibercept) are increasingly used to stabilize active neovascularization.
- Surgical Intervention: Vitrectomy is required for non-clearing vitreous hemorrhage or tractional retinal detachment.
- Educational Resource: For a comprehensive ophthalmology curriculum, high-yield diagrams, and clinical practice questions, visit mymedschool.org.