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Vascular complications
Diabetic eye disease
Retinopathy
- Diabetic retinopathy remains the most common cause of acquired blindness in young and older adults
- Early retinopathy is asymptomatic but may be detected by sensitive methods (e.g. fundus photography or fluorescein angiography) in a large proportion of young people with diabetes duration of more than 10 years
Fluorescein angiography is not performed in many pediatric centers but is a sensitive method of detecting early functional vascular abnormalities of the retina which are potentially reversible by improvements in metabolic control. There is good evidence that serial fundus photography, which is less invasive, is equally effective in the monitoring of retinopathy
Types of retinopathy
Early or background retinopathy
- Microaneurysms
- Hemorrhages
- Hard and soft exudates
- Intra-retinal microvascular abnormalities (IRMA)
Background retinopathy is non-vision-threatening. It may remain stable for years, may sometimes regress, or may progress to more severe retinopathy
Vision-threatening retinopathy
- Macular edema (rare in children)
- Pre-proliferative retinopathy (vascular obstruction, progressive IRMA, infarctions of the retinal nerve fiber layer causing cotton wool spots)
- Proliferative retinopathy (new vessel formation of retina and/or vitreous posterior surface). New vessel formation is responsible for further retinal and vitreous hemorrhage, fibrous reactions and subsequent retinal detachment
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