เทคโนโลยีในการตรวจ รักษาโรคเบาหวานเข้าจอตา โดย พญ. อัจฉรา นิธิอภิญญาสกุล รพ. มหาราชนครราชสีมา
ทบทวนพยาธิวิทยาการเกิด เบาหวานเข้าจอตา
Metabolic Factor of DR phosphatase ATP ADP hexokinase NADPHNADP Aldose reductase hepatocyte NADNADH Polyol dehydrogenase Polyol pathway -Swelling and cellular damage of lens (cataract) -Damage of retinal pericyte (DR) -Basement membrane thickening of vessels (DR) Hyperosmetic gradient
การเปลี่ยนแปลงของ capillary
การเปลี่ยนแปลงในจอประสาทตา
Definition Diabetic Retinopathy Mild NPDR Non proliferative diabetic retinopathy (NPDR) Proliferative retinopathy (PDR) Moderate NPDR Severe NPDR Macular edema
Definition Diabetic Retinopathy Mild NPDR Non proliferative diabetic retinopathy (NPDR) Proliferative retinopathy (PDR) Moderate NPDR Severe NPDR Macular edema Vision threatening DR Non vision threatening DR LASER treatment Good control BS FU every year
Definition of non vision threatening of DR Microaneurysm or dot hemorrthage Mild Non-proliferative Diabetic Retinopathy ( mild NPDR)
Definition of non vision threatening of DR Hard exudate Moderate Non-proliferative Diabetic Retinopathy (Mod NPDR)
Definition of Vision Threatening Diabetic Retinopathy Severe Non-proliferative Diabetic Retinopathy ( severe NPDR) Vessel dilatation 2 Q Hemorrhage>20 in each quadrant of 4 Q Intraretina Microvascular Abnormality (IRMA) 1 Q Rule of 4:2:1
Definition of Vision Threatening Diabetic Retinopathy Proliferative Diabetic Retinopathy (PDR) Neovascularization At elsewhere (NVE) Neovascularization at disc (NVD) Vitrouse hemorrhage Traction retinal detachment
Definition of Vision Threatening Diabetic Retinopathy Proliferative Diabetic Retinopathy (PDR) Neovascularization at disc (NVD) Neovascularization At elsewhere (NVE) Traction retinal detachment Neovascularization at disc (NVD)
Definition of Vision Threatening Diabetic Retinopathy Macular Edema Macular edema or exudate within 500micron Optic disc=1500 micron
DR screening Direct ophthalmoscope Direct ophthalmoscope
DR screening Indirect ophthalmoscope Indirect ophthalmoscope Dilate pupil before eye examination
DR screening Fundus camera Fundus camera
Retina image
Internet consultation
เครื่องมือพิเศษช่วยวินิจฉัยโรค Optical Coherence Tomography Optical Coherence Tomography
LASER Treatment LASER 532 nm LASER multi-wavelengths
Anti VEGF Intra-vitreous injection
LASER Treatment Pattern LASER 532 nm Pattern LASER 532 nm
Retina surgery Indication - Vitrouse Hemorrhage - Tractional Retinal detachment
Retina surgery
Vitrectomy and Endolaser
Vitrectomy and SF6/silicone oil injection
Risk factor of DR Long Duration DM Long Duration DM Uncontrolled DM Uncontrolled DM Hypertension Hypertension Albuminuria or nephropathy Albuminuria or nephropathy Pregnancy Pregnancy
Patients' education Tight control BS (diet, exercise, medication) Control HT Eye examination annually etc
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