Proliferative diabetic retinopathy
Proliferative diabetic retinopathy showing severe
ischaemia (extensive multiple cotton wool spots)
and new vessels in the superotemporal arcade.
Subhyaloid haemorrhage (note the fluid level) in an eye
with old pan-photocoagulation scar.
The retina shows ischaemic changes as described in preproliferative diabetic retinopathy. The optic disc
or the retinal vein(s) contains new vessels. There may be associated pre-retinal haemorrhages.
Look for features of high risk of proliferative diabetic retinopathy (ie. those which may lead to severe
visual loss unless treated with laser):
- disc vessels which are 1/4 or more of the disc area
- any disc vessels associated with pre-retinal or vitreous haemorrhage
- peripheral new vessels associated with pre-retinal or vitreous haemorrhages
Look at the peripheral retina for pan-photocoagulation scars. New scars are white whereas old ones
contain pigment due to retinal pigment epithelium hyperplasia.
1. What does the Diabetic Control and Complications Trial (DCCT) show ?Answer
2. How many laser burns are required in proliferative diabetic retinopathy?