HSNS 367: Diabetic Retinopathy Pathophysiology Nursing Report

This report provides a comprehensive overview of diabetic retinopathy, a microvascular complication of diabetes. It begins by detailing the pathophysiology, explaining how chronic hyperglycemia leads to microvascular damage in the retina. The report then explores diagnostic methods, including retinal screening, fluorescein angiography, and other assessments used to detect and monitor the condition. Furthermore, it discusses various treatment options, such as photocoagulation, pan-retinal photocoagulation, and intravitreal injections, emphasizing their roles in slowing disease progression and managing complications. The report also touches upon the importance of glycemic control and other interventions in managing this condition. This report is a detailed analysis of the disease, its causes, diagnosis, and treatment. It provides a valuable resource for students and healthcare professionals seeking to understand and manage diabetic retinopathy.

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Introduction
Pathophysiology is considered as transformation of pathology with physiology. This essay
highlights on the aspect of ‘Pathophysiology of Diabetic’ retinopathy, linked with the vision
issue or damage related to retina. In addition, the essay will also analyze the reason that promotes
micro-vascular complication linked with this kind of issue. It will also demonstrate the diagnosis
process related to Diabetic retinopathy and treatment of this issue.
Pathophysiology of micro vascular complication of Diabetes retinopathy
As per the pathophysiology approach, fundamental key of micro-vascular complication is linked
with the tissue exposed to the chronic hyperglycemia. According to the research done by most
prestigious institute, UK prospective diabetes it has found that there is a direct relation between
micro vascular complication and control level of glucose. Micro vascular complication is
connected with the predominantly occurrence within the tissue while glucose is mainly
connected with non-dependency of insulin actions within human body parts such as kidney,
retina and so on. In such case, tissues are mainly uncovered to glucose level which connects
interlinks with the blood glucose levels (Zhou et al., 2018). It also focuses on the fact that
development of this complication is actually the outcome of mixture of straight glucose-mediated
endothelial damage with oxidative stress. Pathophysiology changes in the human organs are the
outcomes of retinopathy, neuropathy and nephropathy. As per the study, it has been found that
retinopathy is a major complication in micro vascular diabetes and rising continuously. These
kinds of complications are mainly of two types, one is non-proliferative diabetic retinopathy and
other one is proliferative diabetic retinopathy (Zaccardi et al., 2016). Complications related to
retinopathy mainly occur due to blockage by the abnormal growth of blood vessel. This kind of
complications results in bleeding in the eye, damage vision and detachment of retina (American
Diabetes Association, 2018). This disease is segmented into three stages i.e. mild, moderate and
serious stage that results into development of diabetic macular oedema. In Retinopathy issue, it
has found that almost 60% of the diabetic patient with either Type 1 diabetes or Type 2 Diabetes
faces this kind of issue in their earlier stage. However, this issue is not treated on proper time it
can result into complete blindness. According to pathophysiology approach, it has found that in
earlier stage a change has observed in the retinal blood vessel related to hyperglycemia that
controls the blood flow (Wang et al., 2017). Changes are linked with metabolic auto regulation
that helps increasing the metabolism related to retinal subjects. In addition, loss of pericyte is
observed commonly in the patient suffering from Diabetic retinopathy because this element
triggers the glucose level in both vitro as well as vivo patterns. Pericyte is a support line for
capillaries and therefore any changes in them can lead to damage of capillary wall. In addition
pathophysiology approach of retinopathy is also focused on the exploration of increasing
thickness in membrane along with apoptosis related to endothelial cells (Hinder, et al., 2019 ).
Any change in these elements leads to permanent damage of retina in the Type 1 Diabetes case.
Pathophysiology approach state that there are other factors such as phospholipase elevation that
leads to introduction of unwanted changes thereby increasing the abnormal growth of vascular

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tissue. This further develops conjunction type environment in the retinal functions, and promotes
proliferation by activating mitogen-activated protein is connected with endothelial cells.
Assessment and diagnostics of micro vascular complication of retinopathy diabetes
As this kind of issue is very risky for the health of the patient, therefore in this situation it is very
important to diagnose this micro vascular complication. In this situation, main objective of
assessment of this disease in earlier stage can help the patient in improving their present situation
(Hinder et al., 2019). In this screening process or diagnosis process patient is encouraged to go
through an eye screening process because it is the first stage, which connects all the other
symptoms. This process is called as retinal screening procedure in which visual results of the
patients are analyzed with the help of most advance eye scanner. In some cases, it has been
found that symptoms related to retinopathy diabetes is not possible to explore with normal eye
examination and there required special attention kind of attention from medical experts In this
situation, medical expert will make use of drops in order to dilate pupils (Kret & De Dreu, 2017).
The purpose of this process is to understand the rate of damage happened to the retina with the
help of suffocated lenses.
One of the known tests carried is fluorescein angiography that helps in exploring the changes in
the pattern and operation related to retinal blood vessels. In this test the medical expert make use
of injection which consists of fluorescent, being injected in one of the veins and then picture of
retina is taken to understand the outline related to blood vessels (Spaide, Klancnik & Cooney,
2015). In addition, through a regular checkup of glaucoma along with cataracts helps in
understanding the damage rate linked with the vision issue. This diagnosis program was
established by English national screening program for Diabetic Retinopathy (Roberts et al.,
2018). Diagnosis occurs mainly in two ways. In most of the cases, health care target screening is
preferred because it is the most practical and effective approach of diagnostic, which helps in
lower down the risk, associated with the patient health. This kind of diagnosis is emphasized on
micro vascular issues, increasing in the form of diabetic complications. This screening is
analyzed through examining the development stage of hyperglycemia in the patient, which is
usually linked with the lower prevalence of this disease (De Vita et al., 2019). In addition, this
diagnosis also include the occurrence of retinopathy, weakening of foot sensitivity and microal
Buminuria during the procedure in order to understand the level of risk associated with the health
of the patient.
Treatment for micro vascular complication of Retinopathy diabetes
There is clear link between the degree of glycemic control and risk associated with development
of diabetic retinopathy. One of the best ways is to improve the metabolic control, which will
automatically reduce the development and progression of this micro vascular issue. In addition, it
has observed that insulin therapy helps in reducing risk associated with the development of
retinopathy by lowering down the rate of proliferative up to half level. Moreover, this therapy

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reduces the occurrence of diabetes mellitus especially in case of albuminuria. It also reduces the
risk related to non-fatal myocardial infarction (Billeter et al., 2018). Another option for this
treatment is blocking renin-angiotensin as a mode of protection against negative micro vascular
issue in adults. Decrease in BP is considered as significant option to protect the development of
nephropathy as well as retinopathy. At present time, ACEI treatment has become more popular
among health care professionals being suggested to the patients who are suffering from micro
albuminuric as well as normotensive. Another option in retinopathy diabetes treatment is
photocoagulation process (Bressler et al., 2018). In this process patient is given laser treatment
which helps in slowing the leakage related to the blood and related fluid with in the eye. Laser
beams are used to burn the leakage related to abnormal blood vessel. This kind of treatment may
not help in returning vision but helps in diminishing the development of macular edema, leading
to the damage the vision of the patient (Soares et al., 2017). Another improved treatment is pan
retinal photocoagulation, in this treatment process a beam of scatter laser is used to shrink the
abnormality related to the blood vessels of the eyes. In this process, the area of retina is focused
on macula in order to eliminate the issue of permanent damage (Nikkhah et al., 2018). In some
cases, it has seen that medical experts make use of vitrectomy process to treat the patient with
type 1 diabetes related to retinopathy diabetes. In this process, a small incision is used to
confiscate blood from the middle of the eye that has been coagulated on the retina affecting the
vision of the patient. Another important treatment process is injecting medicine in the eye in
which vitreous is being injected in the eye that decreases the growth rate of new blood vessel by
impacting their signals. It is mainly done in the combination format of Panretinal photo
coagyaltion. This treatment helps in slowing the development related to diabetic retinopathy but
it did not offer permanent cure in case of Type 2 diabetes because diabetes is a lifelong issue and
it cannot be cured completely but can be controlled with the help of appropriate treatment
methods.
Conclusion
Pathophysiology study clearly indicates that the number of retinal issue is increasing in both the
types of diabetic patient i.e. Type 1 or Type 2. In this situation, it has become essential for the
patient to go through diagnosis process in order to understand the present condition of their
health. This will help in understanding the method of treatment, suitable for the present health
issue because same treatment method cannot be applied in all the cases. Thus, Panretinal
photocoagyaltion and photocoagyaltion are some of the vital methods of treatments used to
manage the retinopathy issue.

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References
American Diabetes Association. (2018). 10. Microvascular complications and foot care:
Standards of Medical Care in Diabetes-2018. Diabetes Care, 41(1), S105.
Billeter, A. T., Scheurlen, K. M., Probst, P., Eichel, S., Nickel, F., Kopf, S., & Müller‐Stich,
B. P. (2018). Meta‐analysis of metabolic surgery versus medical treatment for
microvascular complications in patients with type 2 diabetes mellitus. British journal of
surgery, 105(3), 168-181.
Bressler, S. B., Beaulieu, W. T., Glassman, A. R., Gross, J. G., Melia, M., Chen, E., ... &
Diabetic Retinopathy Clinical Research Network. (2018). Panretinal Photocoagulation
Versus Ranibizumab for Proliferative Diabetic Retinopathy: Factors Associated with
Vision and Edema Outcomes. Ophthalmology, 125(11), 1776-1783.
De Vita, A., Manfredonia, L., Lamendola, P., Villano, A., Ravenna, S. E., Bisignani, A., ... &
Crea, F. (2019). Coronary microvascular dysfunction in patients with acute coronary
syndrome and no obstructive coronary artery disease. Clinical Research in Cardiology, 1-
7.
Hinder, L. M., Sas, K. M., O’Brien, P. D., Backus, C., Kayampilly, P., Hayes, J. M., ... &
Abcouwer, S. F. (2019). Mitochondrial uncoupling has no effect on microvascular
complications in type 2 diabetes. Scientific reports, 9(1), 881.
Hinder, L. M., Sas, K. M., O’Brien, P. D., Backus, C., Kayampilly, P., Hayes, J. M., ... &
Abcouwer, S. F. (2019). Mitochondrial uncoupling has no effect on microvascular
complications in type 2 diabetes. Scientific reports, 9(1), 881.
Kret, M. E., & De Dreu, C. K. (2017). Pupil-mimicry conditions trust in partners: Moderation
by oxytocin and group membership. Proceedings of the Royal Society B: Biological
Sciences, 284(1850), 20162554.
Nikkhah, H., Ghazi, H., Razzaghi, M. R., Karimi, S., Ramezani, A., & Soheilian, M. (2018).
Extended targeted retinal photocoagulation versus conventional pan-retinal
photocoagulation for proliferative diabetic retinopathy in a randomized clinical
trial. International ophthalmology, 38(1), 313-321.
Roberts, T. J., Burns, A. T., MacIsaac, R. J., MacIsaac, A. I., Prior, D. L., & La Gerche, A.
(2018). Diagnosis and significance of pulmonary microvascular disease in
diabetes. Diabetes care, 41(4), 854-861.
Soares, M., Neves, C., Marques, I. P., Pires, I., Schwartz, C., Costa, M. Â., & Cunha-Vaz, J.
(2017). Comparison of diabetic retinopathy classification using fluorescein angiography

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and optical coherence tomography angiography. British Journal of
Ophthalmology, 101(1), 62-68.
Spaide, R. F., Klancnik, J. M., & Cooney, M. J. (2015). Retinal vascular layers imaged by
fluorescein angiography and optical coherence tomography angiography. JAMA
ophthalmology, 133(1), 45-50.
Wang, C., Ye, Y., Sun, W., Yu, J., Wang, J., Lawrence, D. S., & Gu, Z. (2017). Red blood
cells for glucose‐responsive insulin delivery. Advanced Materials, 29(18), 1606617.
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and
type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084),
63-69.
Zhou, H., Wang, S., Zhu, P., Hu, S., Chen, Y., & Ren, J. (2018). Empagliflozin rescues
diabetic myocardial microvascular injury via AMPK-mediated inhibition of
mitochondrial fission. Redox biology, 15, 335-346.