Which physical findings are characteristic of diabetic retinopathy in pediatric type 1 diabetes mellitus (DM)?

Updated: Jul 03, 2019
  • Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

The first symptoms of diabetic retinopathy are dilated retinal venules and the appearance of capillary microaneurysms, a condition known as background retinopathy. These changes may be reversible or their progression may be halted with improved diabetic control, although in some patients the condition initially worsens.

Subsequent changes in background retinopathy are characterized by increased vessel permeability and leaking plasma that forms hard exudates, followed by capillary occlusion and flame-shaped hemorrhages. The patient may not notice these changes unless the macula is involved. Laser therapy may be required at this stage to prevent further vision loss.

Proliferative retinopathy follows, with further vascular occlusion, retinal ischemia, and proliferation of new retinal blood vessels and fibrous tissue; the condition then progresses to hemorrhage, scarring, retinal detachment, and blindness. Prompt retinal laser therapy may prevent blindness in the later stages, so regular screening is vital.


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