David Kinshuck Associate specialist ophthalmology Good Hope www

David Kinshuck Associate specialist ophthalmology Good Hope & www. diabeticretinopahty. org. uk DIABETIC RETINOPATHY IN PREGNANCY

Diabetic retinopathy in pregnancy What is diabetic retinopathy Mechanisms Identification. . screening Treatment Prevention Where next

What is diabetic retinopathy

What is diabetic retinopathy

High glucose IGF 1, other growth factors, smoking, blood pressure Capillary leakage & new vessel growth Retinal ischaemia

Retinal ischaemia, PREGNANCY, IGF 1, other growth factors, smoking, blood pressure VEGF: vascular endothelial growth factor Capillary leakage & new vessel growth Loss of central vision Detached retina and blindness

http: //www. diabeticretinopathy. org. uk/dmre t. html

Screening for diabetic Red free Photographs Selected optometrists Some outpatient clinics

Screening for diabetic

Treatment or diabetic retinopathy when pregnant 1. Laser 2. (no anti-VEGF injections) 3. Intravitreal steroids (injection into the eye) 4. Controlling glucose, bood pressure, smoking, antioxidants

Laser

Prevention Nursing support Low Hb. A 1 c Pumps? glucose sensors

Lowering Hb. A 1 c quickly Makes the retinopathy worse Have to accept this

Where next Never let the control get poor Pumps, sensors, Effective nursing support Effective organisation Much more effective mental health care