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LETTER TO THE EDITOR
Year : 2008  |  Volume : 56  |  Issue : 5  |  Page : 440-441

Diabetic retinopathy: New proposed classification


Department of Ophthalmology, Dubai Hospital, PO Box 7272, Dubai, United Arab Emirates

Date of Web Publication8-Aug-2008

Correspondence Address:
Prasan M Rao
Department of Ophthalmology, Dubai Hospital, PO Box 7272, Dubai
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.42432

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How to cite this article:
Rao PM. Diabetic retinopathy: New proposed classification. Indian J Ophthalmol 2008;56:440-1

How to cite this URL:
Rao PM. Diabetic retinopathy: New proposed classification. Indian J Ophthalmol [serial online] 2008 [cited 2020 Oct 30];56:440-1. Available from: https://www.ijo.in/text.asp?2008/56/5/440/42432

Dear Editor,

We read with interest the article on the newer classification of diabetic retinopathy by Dubey et al. [1] and would like to share our views regarding the concept of vitreoretinal traction in diabetic retinopathy. The authors should be praised for adding a new dimension to the classification of diabetic retinopathy.

The authors have mentioned that progressive vitreoretinal traction can produce tractional retinal detachment, secondary rhegmatogenous retinal detachment, persistent macular edema and various types of vitreous hemorrhage. These findings have been classified in the group "secondary diabetic vitreopathy". However, the authors have not included tractional schisis (either macular or non-macular in location) secondary to vitreous contraction in the classification.

Lincoff et al., have described the entity of "tractional schisis" resulting from splitting of the inner retina and causing an elevation of the retina similar to tractional retinal detachment. [2] Differentiating between the two conditions is important, as the indications of surgery and prognosis may differ between them. The features of schisis are symmetrical elevation below the point of traction, slow progression, absence of pigment demarcation line, failure to spread rapidly in the presence of a tear. Vitrectomy in these eyes is less risky, because of lack of rapid progression of retinal detachment in the event of iatrogenic retinal breaks. In eyes with longstanding tractional schisis, the vessels in the elevated layer get obliterated; the elevated layer disintegrates and resembles a large partial-thickness retinal hole.

Tractional retinoschisis with or without retinal detachment was the most frequent pattern of tractional macular elevation in eyes with proliferative diabetic retinopathy and observed in 94% of eyes as reported by Imai et al . [3] Optical coherence tomography (OCT) imaging in eyes with relatively clear overlying vitreous can be useful in differentiating between schisis and detachment. The splitting plane is thought to be the outer plexiform layer. [4] Visual recovery after vitrectomy may be greater in eyes with tractional macular detachment rather than eyes with schisis involving the macula.

Dubey's classification of diabetic retinopathy prognosticates the various manifestations of the disease process. Thus, we hope that the authors would also include non-macular and macular tractional schisis in their classification, not only for the sake of completion, but also as differentiating schisis from tractional detachment is useful for the management and prediction of possible recovery of central vision.

 
  References Top

1.
Dubey AK, Nagpal P, Chawla S, Dubey B. A proposed new classification for diabetic retinopathy: The concept of primary and secondary vitreopathy. Indian J Ophthalmol 2008;56:23-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Lincoff H, Kreissig I. Patterns of non-rhegmatogenous elevations of the retina. Br J Ophthalmol 1974;58:899-906.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Imai M, Iijima H, Hanada N. Optical coherence tomography of tractional macular elevations in eyes with proliferative diabetic retinopathy. Am J Ophthalmol 2001;132:458-61.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Faulborn J, Ardjomand N. Tractional retinoschisis in proliferative diabetic retinopathy: A histopathological study. Grafes Arch Clin Exp Ophthalmol 2000;238:40-4.  Back to cited text no. 4
    



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Dubey, A.K., Nagpal, P.N., Chawla, S., Dubey, B.
Indian Journal of Ophthalmology. 2008; 56(5): 441
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