الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
I
n 2019, a total of 463 million people are estimated to be living with diabetes, representing 9.3% of the global adult population (20–79 years). This number is expected to increase to 578 million (10.2%) in 2030 and 700 million (10.9%) in 2045. Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes worldwide. The prevalence of type 2 diabetes is high and increasing across all regions worldwide. This increase is caused by population aging, economic development and increasing urbanization leading to more sedentary lifestyles and more consumption of unhealthy foods linked with obesity
International diabetes federation (IDF) has identified Egypt as the ninth leading country in the world for number of patients with diabetes mellitus and expected to be the 7th in prevalence of diabetes mellitus globally of all adults aged 20-79 years old. According to the International diabetes Federation (IDF) there will be 16.9 million people with diabetes in Egypt in 2045.
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. It is one of the leading causes of blindness in the working age population and has a great economic impact on society especially on healthcare systems.
The two main types of diabetic retinopathy (DR) are the less-severe form, non-proliferative diabetic retinopathy (NPDR) which divided into mild, moderate and severe and the severe form of DR, proliferative diabetic retinopathy (PDR).
The prevalence of any type of diabetic retinopathy in people who have diabetes was estimated to be 35% with vision threatening DR present in 12% by using retinal images. from 1990–2010, DR ranked as the fifth most common cause of preventable blindness and fifth most common cause of moderate to severe visual impairment.
Duration of diabetes, poor control of blood glucose, age, and hypertension are major risk factors for rapid progression of RD.
Proper management of DR lead to prevention of more than 90% of cases of vision impairment will occur, so it is quite important to distinguish, classify and stage the severity of DR to set the proper management.
Management of diabetic retinopathy includes following a healthy diet and lifestyle, medical management, timely ophthalmic evaluation, and treatment under the care of an ophthalmologist.
Physicians and patients need to be educated and informed of the need for ophthalmic referral and routine surveillance. Screening for DR, early diagnosis of DR is the best strategy to prevent or delay loss of vision.
Methods of diagnosing diabetic retinopathy clinically include ophthalmoscope, optical coherence tomography (OCT), retinal photography and fundus fluorescein angiography (FFA).
Optical coherence tomography (OCT) and fundus photography are noninvasive examinations help the clinician to observe signs of neurodegenerative changes in the retina and detects neuroretinal changes in the early stages of DR and DME.
OCT enables precise measurement of macular thickness. Thus, it facilitates detecting macular edema which is the main pathologic feature of diabetic maculopathy. It can also reveal hard exudates and hemorrhages.
Fundus photography (with or without pupillary dilation) is a reproducible technique for detecting diabetic retinopathy and has been used in large clinical research studies. Fundus photography is also useful for documenting the severity of the diabetes, the presence of new vessels elsewhere in the retina and NVD, the response to treatment, and the need for additional treatment at future visits.
This study conducted to estimate the prevalence and severity of diabetic retinopathy and diabetic macular edema among patients with diabetes mellitus type 2 over 30 years old. Using fundus photography and optical coherence topography (SD-OCT) at National Institute of Diabetes and Endocrinology.
This study included 600 eyes from 300 patients. Diabetics were recruited from patient recruited from National institute of Diabetes and endocrinology in the ophthalmic clinic. It was designed as cross sectional hospital based study.
The study population includes:
1- Both sex (males & females).
2- Diabetic patients age more than 30 years old type2 diabetes mellitus.
3- Good fundus view.
The study exclusion Criteria:
1- Unclear media as corneal opacity eyes with advanced cataract.
2- History of other retinal pathology due to any cause other than diabetes mellitus as central retinal vein occlusion, radiation retinopathy or hypertensive retinopathy.
All patients were photographed by using Spectral Domain OCT (SDOCT) (nidek RS- 3000 advance) to acquire central macular thickness and morphology. from the SD-OCT macula map and cross sectional captures the presence and severity of diabetic macular edema was graded into Nontractional DME: Spongiform-like, cystoid edema, serous retinal detachment or Tractional DME.
Retinal photographs were obtained after pupillary dilatation. All patients underwent 45° digital photography by TopconTRC. NW8F using red free filter. from the digital photographs obtained, the presence and severity of diabetic retinopathy were categorized according to the international clinical DR severity scales into no diabetic retinopathy, mild, moderate, and severe/very severe non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) as per International Clinical Diabetic Retinopathy and Diabetic Macular Edema Disease Severity Scales.
The findings of our study showed that the prevalence of DR irrespective to type was 34% of studied eyes. Also it revealed that 22.3% of studied eyes had diabetic macular edema.
Non-proliferative diabetic retinopathy in our study was more common than proliferative diabetic retinopathy. The prevalence of non-proliferative diabetic retinopathy in DR patients in our study was (72.5%) but proliferative diabetic retinopathy (27.5%) in DR patients. The commonest type was mild NPDR (33.3%).
There is a strong relation between duration of DM, control of HbA1c, age, treatment with insulin and DR and DME. The longer duration of DM and high levels of HbA1c considered main risk factors of DR and DME.