Hopp til hovedinnhold

Diabetisk retinopati

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Retinopati som følge av progressiv mikroangiopati forårsaket av type 1- eller type 2-diabetes
Forekomst:
Foreligger hos en tredel av pasienter med nyoppdaget type 2-diabetes. Etter 5 år har ca. 10% øyenbunnsforandringer. 
Symptomer:
Få tidlig i sykdomsforløpet fordi endringene vanligvis starter perifert i retina
Funn:
Kan etter hvert påvise retinaforandringer som mikroaneurysmer, små blødninger, hvitlige eksudater. Kan også foreligge katarakt, svekket refraksjon, i noen tilfeller dobbeltsyn
Diagnostikk:
Rutinemessig screening hos øyelege
Behandling:
Primært best mulig kontroll over diabetes og ev. hypertensjon. Sekundært laserfotokoagulasjon, ev. bruk av lokalt veksthemmende middel
  1. Fosmark D, Bertelsen G, Gran Erke M. Diabetesretinopati. Nasjonal kvalitetshåndbok for oftalmologi. Sist revidert 2017. www.helsebiblioteket.no  
  2. Bek T. Øjenkomplikationer ved type 2-diabetes. Ugeskr Læger 2012; 174: 2147. Ugeskrift for Læger  
  3. Åsvold BO, Espeland K, Bjørgaas MR, Grill V. Redusert forekomst av proliferativ retinopati ved type 1-diabetes. Tidsskr Nor Legeforen 2011; 131: 17-9. doi:10.4045/tidsskr.09.0490 DOI  
  4. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, Nathan DM, Zinman B, et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005). Arch Intern Med 2009; 169:1307. PubMed  
  5. Gallego PH, Craig ME, Hing S, Donaghue KC. Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study. BMJ 2008; 337: a918. PubMed  
  6. Ryan ME, Rajalakshmi R, Prathiba V, et al. Comparison among methods of retinopathy assessment (CAMRA) study. Smartphone, nonmydriatic, and mydriatic photography. Ophtalmology. Published Online: July 15, 2015 . doi:http://dx.doi.org/10.1016/j.ophtha.2015.06.011
  7. Helsedirektoratet. Nasjonale faglig retningslinje for diabetes. Oslo; Helsedirektoratet 2016 helsedirektoratet.no  
  8. ACCORD Study Group; ACCORD Eye Study Group, Chew EY, Ambrosius WT, et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 2010; 363: 233-44. PubMed  
  9. Virk SA, Donaghue KC, Wong TY, Craig ME. Interventions for diabetic retinopathy in type 1 diabetes: Systematic review and meta-analysis. Am J of Ophtalmology, published online July 22, 2015 . doi:http://dx.doi.org/10.1016/j.ajo.2015.07.024
  10. The DCCT/EDIC Research Group. Intensive Diabetes Therapy and Ocular Surgery in Type 1 Diabetes. N Engl J Med 2015; 372: 1722-33. doi:10.1056/NEJMoa1409463 DOI  
  11. Do DV, Wang X, Vedula SS, et al. Blood pressure control for diabetic retinopathi. Cochrane Database Syst Rev 2015; 1: CD006127. doi:10.1002/14651858.CD006127.pub2 DOI  
  12. Chaturvedi N, Porta M, Klein R et al, for the DIRECT programme study group. Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials. Lancet 2008; 372: 1394-1402. PubMed  
  13. Marcovecchio ML, Chiesa ST, Bond S, et al. ACE Inhibitors and Statins in Adolescents with Type 1 Diabetes. N Engl J Med 2017; 377:1733. New England Journal of Medicine  
  14. Nguyen QD, Shah SM, Heier JS et al, READ-2 Study Group. Primary end point (six months) results of the Ranibizumab for Edema of the Macula in diabetes (READ-2) study. Ophthalmology 2009; 116: 2175-81. PubMed  
  15. Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti‐vascular endothelial growth factor for diabetic macular oedema: a network meta‐analysis. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD007419. DOI: 10.1002/14651858.CD007419.pub6. The Cochrane Library  
  16. Gardlik R, Fusekova I. Pharmacologic therapy for diabetic retinopathy. Semin Ophthalmol. 2015 ; 30(4): 252-63. pmid:24571780 PubMed  
  17. Das A, Stroud S, Mehta A, Rangasamy S. New treatments for diabetic retinopathy. Diabetes Obes Metab. 2015;17:219-30. pmid:25160598 PubMed  
  18. The Diabetic Retinopathy Clinical Research Network. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema. N Engl J Med 2015; 372: 1193-1203. doi:10.1056/NEJMoa1414264 DOI  
  19. Evans JR, Michelessi M, Virgili G. Laser photocoagulation for proliferative diabetic retinopathy. Cochrane Database of Syst Rev 2014; 11: CD011234. doi:10.1002/14651858.CD011234.pub2 DOI  
  20. Smith JM, Steel DH. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2015 Aug 7;8:CD008214. doi: 10.1002/14651858.CD008214.pub2. DOI  
  21. Jhaveri CD, Glassmann AR, Ferris FL, et al. Aflibercept Monotherapy or Bevacizumab First for Diabetic Macular Edema. N Engl J Med 2022; 387: 692-703. pmid:35833805 PubMed  
  22. Sjølie AK, Klein R, Porta M et al, for the DIRECT programme study group.. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet 2008; 372: 1385-93. PubMed  
  23. Fraser CE, D'Amico DJ, Shah AR. Diabetic retinopathy: Prevention and treatment. UpToDate, last updated Oct 29, 2019. UpToDate  
  24. Sala-Vila A, Díaz-López A, Valls-Pedret C, et al. Dietary marine ω-3 fatty acids and incidente sight-threatening retinopathy in middle-aged and older individuals with type 2 diabetes. Prospective investigation from the PREDIMED trial. JAMA Ophtalmol 2016. doi:10.1001/jamaophthalmol.2016.2906 DOI  
  25. Grauslund J. Treatment of sight-threatening diabetic retinopathy. Ugeskr Laeger. 2018 Jul 30;180(31):V11170870. Danish. PMID: 30064622.
  26. Leasher JL, Bourne RR, Flaxman SR et al. Vision Loss Expert Group of the Global Burden of Disease Study. Global Estimates on the Number of People Blind or Visually Impaired by Diabetic Retinopathy: A Meta-analysis From 1990 to 2010. Diabetes Care. 2016 Sep;39(9):1643-9. doi: 10.2337/dc15-2171. Erratum in: Diabetes Care. 2016 Nov;39(11):2096. PMID: 27555623. PubMed  
  27. Amoaku WM, Ghanchi F, Bailey C et al. Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond). 2020 Jun;34(Suppl 1):1-51. Erratum in: Eye (Lond). 2020 Oct;34(10):1941-1942. PMID: 32504038 PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Tor Claudi, spesialist i allmennmedisin og indremedisin, Rønvik legesenter, Bodø og NOKLUS-klinikk, Bergen
  • Johan H. Seland, professor emeritus, Universitetet i Bergen
  • Knut A. Holtedahl, professor i allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Tromsø