Rhenus:state definitions
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[edit] State Definitions
In order to avoid definition problems we describe below what characterises each single state and what separates them. Be aware that the term diabetic retinopathy, used in literature, can mean diabetic retinopathy and diabetic maculopathy or only diabetic retinopathy - without diabetic maculopathy.
[edit] No Retinopathy
Diabetic retinopathy and diabetic maculopathy are absent. But other ailments are not necessarily excluded.
[edit] Non-Proliferative Retinopathy
This state can be subdivided into mild, moderate and severe non-proliferative retinopathy. It varies from microaneurysm in the mild form and/or several intraretinal haemorrhage venous dilating/beading in the moderate form to a large number (≥ 20) of haemorrhages in each of 4 quadrants and/or or venous beading in at least 2 quadrants and/or or intraretinal microvascular abnormalities (IRMA) in a single quadrant, in the severe form. All three subdivisions are summarised in the state Non-Proliferative Retinopathy.
Reference:
- Nationale VersorgungsLeitlinie Typ-2-Diabetes, 2. Auflage - Thema Netzhautkomplikationen, 04 / 2008 Version 2.4
- Diagnostik, Therapie und Verlaufskontrolle der diabetischen Retinopathie und Makulopathie Evidenzbasierte Leitlinie DDG Aktualisierung 11/2004
[edit] Proliferative Retinopathy
is characterized by neovascularization of the retina and optic disc (which may project into the vitreous) and retinal detachment.
Reference:
[edit] Diabetic Macula Edema
Diabetic maculopathy has to be distinguished from age related maculopathy, which is not diabetes dependent. Be careful when doing literature research, as there might be the danger of mixing it up.
Diabetic maculopathy can be subdivided into focal, diffuse and ischaemic maculopathy. The status of focal diabetic maculopathy is defined by appearance of leakage (edema) from a few specific spots, hard extrudes and intra retinal haemorrhage occurring at polus posterior lentis and close to the macula. Diffuse maculopathy is present when extensive edema appears at the macula and beyond, accompanied by hard extrudes an intra retinal haemorrhage. Ischaemic maculopathy is defined by appearance of spaciously perfusion deficit of the capillary network around the fovea. Hybrid forms of diabetic maculopathy are possible.
If maculopathy is present, there can simultaneous occur forms (as described above) of non-proliferative or proliferative retinopathy. This state covers all kinds of combination of maculopathy and retinopathy. It is named after maculopathy due to its fatal consequences.
Reference:
[edit] Blindness
Blindness is defined by the visual acuity. Here we find a discrepancy between a german definition and a definition given by the World Health Organisation (WHO). The german definition of blindness is postulated as visual acuity ≤ 0.02 in the less effected eye. The WHO uses a visual acuity ≤ 0.05 for defining blindness. You should be aware of this, when you are are doing literature research. In the PROSIT Rhenus Model we use ...?!? (needs to be checked)
Reference:
[edit] Death
Coroner's inquest. Each cause of death can lead into this absorbing state.