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Diabetic Retinopathy – Pathogenesis and Clinical Features Snježana Kaštelan; Martina Tomić; Željka Rogulja-Pepeonik & Višnja Mrazovac Abstract Diabetic retinopathy, the most common microvascular complication of diabetes mellitus, is estimated to be the leading cause of blindness in the working population in developed countries. The prevalence of retinopathy increases with the duration of diabetes and is related to hyperglycemia, hypertension, hyperlipidemia, pregnancy, nephropathy and anemia. The retina is a metabolically active tissue, and various biochemical, immunological and genetic mechanisms have been implicated in the pathogenesis of retinopathy. Vascular disruptions are characterized by abnormal autoregulation of retinal blood flow caused by loss of the pericytes, breakdown of the inner blood-retinal barrier, thickening of the capillary basement membrane as well as damage and proliferation of endothelial cells. Characteristic clinical manifestations are the result of four main processes: the appearance of microaneurysms, increased vascular permeability, capillary occlusion, and fibrovascular proliferation. The clinical stage of diabetic retinopathy is further divided into nonproliferative and proliferative phases. Diabetic maculopathy refers to involvement of the macula by oedema and hard exudates (focal, diffuse, exudative) or ischaemia (ischaemic maculopathy). It may accompany both clinical phases of diabetic retinopathy. The most common causes of visual loss in diabetic patients are diabetic maculopathy and proliferative diabetic retinopathy. Diagnosing diabetic retinopathy and maculopathy requires a combination of clinical examination and diagnostic imaging techniques, which includes direct or indirect ophthalmoscopy through dilated pupil, color fundus photography, fluorescein angiography, optical coherence tomography and other imaging techniques. All patients with diabetes require frequent ophthalmologic examinations to allow early detection of disease and appropriate intervention in order to prevent blindness. Keywords clinical features; diabetic retinopathy; diagnosis; pathogenesis

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Dijabetička retinopatija – patogeneza i klinička slika Snježana Kaštelan; Martina Tomić; Željka Rogulja-Pepeonik & Višnja Mrazovac Dijabetička retinopatija najčešća je mikrovaskularna komplikacija šećerne bolesti i jedan od vodećih uzroka novonastale sljepoće radno sposobnih osoba u razvijenim zemljama. Prevalencija retinopatije povećava se s trajanjem šećerne bolesti , a usko je povezana i s nazočnošću hiperglikemije, hipertenzije, hiperlipidemije, trudnoće, nefropatije i anemije. Budući da se retina smatra metabolički aktivnim tkivom, u patogenezi dijabetičke retinopatije važnu ulogu imaju različiti biokemijski, imunološki i nasljedni mehanizmi. Patofiziološke odlike dijabetičke retinopatije su poremećaj autoregulacije retinalnog krvotoka uslijed gubitka pericita, oštećenje unutarnje krvno - retinalne barijere, zadebljanje bazalne membrane kapilara te oštećenje i proliferacija endotelnih stanica. Karakteristične kliničke promjene posljedica su četiriju procesa: formiranja mikroaneurizmi, povećanja propusnosti krvnih žila, okluzije kapilara te neovaskularne i fibrozne proliferacije. Prema kliničkoj slici dijabetička retinopatija dijeli se na neproliferativnu i proliferativnu. Dijabetička makulopatija predstavlja nazočnost edema s tvrdim eksudatima (fokalna, difuzna, eksudativna) ili ishemije (ishemična makulopatija) u makularnom području, a može biti pridružena i neproliferativnoj i proliferativnoj dijabetičkoj retinopatiji. Glavni uzroci gubitka vida u bolesnika sa šećernom bolesti su dijabetička makulopatija i proliferativna dijabetička retinopatija. Dijagnoza dijabetičke retinopatije i makulopatije postavlja se pregledom očne pozadine, nakon širenja zjenica, direktnom ili indirektnom oftalmoskopijom, fotografijama fundusa u boji, fluoresceinskom angiografijom, optičkom koherentnom tomografi jom i ostalim metodama. Redovitim oftalmološki pregledi svih bolesnika sa šećernom bolesti imaju važnu ulogu u ranom otkrivanju i pravovremenom liječenju bolesti kojima je cilj sprječavanje sljepoće. dijabetička retinopatija; dijagnostika; klinička slika; patogeneza

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