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Glossophobia. Fluctuating vision. Endothelial Cells & Pericytes. Stages of diabetic retinopathy. Nonproliferative diabetic retinopathy. Diabetic Macular Edema. Proliferative diabetic retinopathy (PDR). Hemorrhages, fibro-vascular scaring and ischemia. Nonproliferative retinopathy.
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Stages of diabetic retinopathy • Nonproliferative diabetic retinopathy. • Diabetic Macular Edema. • Proliferative diabetic retinopathy (PDR). • Hemorrhages, fibro-vascular scaring and ischemia.
Laser and Sugar • Diabetic Retinopathy Study (DRS- 1976) • Early Treatment Diabetic Retinopathy Study (ETDRS -1979) • Diabetic retinopathy vitrectomy study (DRVS-1989) • The Diabetes Control and Complications trial (DCCT-1993) • Action to Control Cardiovascular Risk in Diabetes (ACCORD-2009)
The Diabetes Control and Complications trial (DCCT-1993) • The study showed: keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage caused by diabetes. • Eye disease 76% reduced risk • Kidney disease 50% reduced risk • Nerve disease 60% reduced risk
Action to Control Cardiovascular Risk in Diabetes (ACCORD-2009) • Action to Control Cardiovascular Risk in Diabetes (ACCORD-2009) • Glucose control: Intensive blood sugar control reduced the progression of diabetic retinopathy compared with standard blood sugar control. • Cholesterol control: combination lipid therapy with a fibrate and statin also reduced disease progression compared with statin therapy alone. • Blood pressure: Intensive blood pressure control provided no additional benefit to patients compared with standard blood pressure control. • WHAT!!...” intensive blood sugar control to near normal glucose levels increased the risk of death (22% higher) and severe low blood sugar, so patients and their doctors must take these potential risks into account when implementing a diabetes treatment plan.”
Paradigm Shift – Anti-VEGF • DRCR.net • Protocol I: For DME which is better? Lucentis (anti-VEGF), Laser, or Steroid. • Protocol T: For DME which is Anti-VEGF better Which anti VEGF is better? Lucentis, Avastin, Eyelea • Protocol S: For PDR which is better Laser or Avastin (Anti-VEGF)