Abstract
Retinal vascular changes other than diabetic retinopathy (DRP) namely microaneurysms, intraretinal microvascular abnormalities so called IRMA, microinfarctions, hemorrhages, lipid exudates and edema, as well as venous beading and new vessels (NV) on the disk and/or on the retina and their sequalae pre-retinal and vitreous hemorrhages and fibrovascular proliferations and vitreoretinal tractions are common in diabetic patients. These changes are general or focal arteriolar narrowing or arteriolar or venous dilatation, arteriolar sinusoidal elongation or straightening, venous tortuosity, increased arteriolar wall reflex and arterio-venous crossing signs. They reflect cumulative response to aging, cardiovascular risk factors such as hyperglycemia, hypertension and dyslipidemia, as well as inflammation and endothelial dysfunction. Retinal vascular changes are under the influence of both systemic and environmental as well as genetic factors and serve as cardiovascular risk stratification indicator. Furthermore, these changes may cause as such ocular morbidity and threaten vision and influence the occurrence and progression of DRP. Many of these changes were recognized soon after the invention of ophthalmoscope by von Helmholz in 1851 and have since been described in literature. Many of these changes can be accurately measured today.
Highlights
Retinal vascular changes other than diabetic retinopathy (DRP) namely microaneurysms, intraretinal microvascular abnormalities so called IRMA, microinfarctions, hemorrhages, lipid exudates and edema, as well as venous beading and new vessels (NV) on the disk and/or on the retina and their sequalae pre-retinal and vitreous hemorrhages and fibrovascular proliferations and vitreoretinal tractions are common in diabetic patients
The central retinal artery courses adjacent to the central retinal vein within the optic nerve and within the globe, where it branches into four major trunks, each of which supplies a quadrant of the retina
The central retinal artery supplies the inner two-thirds of the retina, the most anterior portion of the optic nerve head, and to some extent the retrolaminar optic nerve
Summary
The vascular endothelium generates basal levels of superoxide anions and can be stimulated to produce deleterious amounts of these molecules during many pathologic conditions. Another component of the retinal microvascular autoregulatory system is the renin-angiotensin pathway. In addition to intraretinal hemorrhages, lipid exudates and retinal edema, retinal microinfarctions, IRMA as well as venous beading they occur in various combinations and increase in number and disappear over the years They result either from vascular leakage or from vaso-occlusion or both and may as such cause visual disturbance, namely macular edema which is the most common cause of visual impairment among diabetic patients.
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