The exact cause of diabetic microvascular disease is unknown.

It is believed that exposure to hyperglycemia

over an extended period results in biochemical and physiologic changes that ultimately cause endothelial
damage. Specific retinal capillary changes include selective loss of pericytes and basement membrane
thickening, changes that favor capillary occlusion and retinal nonperfusion (Fig 5-1), as well as
decompensation of the endothelial barrier function, which allows serum leakage and retinal edema to occur.
The stages of disease represent a continuous progression of the retinovascular damage with a seemingly
stepwise clinical progression from mild stages to advanced proliferative changes. The pace of the progression
varies among patients and depends mainly on systemic factors such as control of blood pressure, blood lipid
concentrations, and glucose levels, among others.
Numerous hematologic and biochemical abnormalities have been correlated with the
prevalence and severity of retinopathy:
increased platelet adhesiveness
increased erythrocyte aggregation
abnormal levels of serum lipids
defective fibrinolysis
abnormal levels of growth hormone
upregulation of vascular endothelial growth factor (VEGF)
abnormalities in serum and whole-blood viscosity
local and systemic inflammation

Banyak hematologi dan kelainan biokimia telah berkorelasi dengan

prevalensi dan keparahan retinopati antara lain.
daya lekat platelet meningkat
peningkatan agregasi eritrosit
tingkat abnormal lipid serum
fibrinolisis cacat
tingkat abnormal hormon pertumbuhan
peningkatan regulasi vascular endothelial growth factor (VEGF)
kelainan pada serum dan seluruh darah viskositas
peradangan lokal dan sistemik
The terminology used for types of diabetes mellitus has evolved over the years. The American Diabetes
Association (ADA) classifies diabetes mellitus as type 1 diabetes mellitus, formerly known as insulindependent diabetes mellitus (IDDM), and type 2 diabetes mellitus, formerly known as non-insulin-dependent
diabetes mellitus (NIDDM). In type 1 diabetes mellitus there is B-cell destruction, usually leading to absolute
insulin deficiency. This process is either idiopathic or immune mediated. Type 2 diabetes mellitus ranges
from a condition characterized as predominantly insulin resistance with relative insulin deficiency to one that
is predominantly an insulin secretory defect with insulin resistance. Other forms of diabetes mellitus are
recognized, including a genetically mediated form secondary to endocrinopathies and drug- or chemicalinduced diabetes mellitus.
The classification of diabetic retinopathy is based on clinical features. Nonproliferative diabetic retinopathy
(NPDR) refers to the presence of intraretinal vascular changes without the presence of extraretinal
fibrovascular tissue; it is further subdivided into mild, moderate, and severe. NPDR is also referred to as
background diabetic retinopathy, a term that is still commonly used but not recommended. Clinically significant
diabetic macular edema (CSDME) is present when minimal severity criteria for macular edema have been
met. In proliferative diabetic retinopathy (PDR), ischemia-induced neovascularization from diabetes
and the associated complications are noted. PDR is further described as early, highrisk, or advanced. In
describing study results, the BCSC uses the terminology used by the individual studies, even if it does not
conform to current terminology.

Klasifikasi
retinopati
diabetik
didasarkan
pada
gambaran
klinis.
Nonproliferative retinopati diabetik (NPDR) mengacu pada adanya perubahan
vaskular intraretinal tanpa hadirnya jaringan fibrovascular extraretinal; itu
dibagi lagi menjadi ringan, sedang, dan berat. NPDR juga disebut sebagai latar
belakang retinopati diabetes, sebuah istilah yang masih umum digunakan tapi
tidak direkomendasikan. Klinis yang signifikan diabetes macular edema
(CSDME) hadir ketika kriteria keparahan minimal untuk edema makula telah
tercapai. Dalam proliferatif retinopati diabetik (PDR), iskemia-induced
neovaskularisasi dari diabetes dan komplikasi yang terkait dicatat. PDR lebih
lanjut digambarkan sebagai awal, resiko tinggi, atau lanjutan. Dalam
menggambarkan hasil studi, BCSC menggunakan terminologi yang digunakan
oleh studi individu, bahkan jika itu tidak sesuai dengan terminologi saat ini