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Ophthalmology > 2: Diabetic and HTN Retinopathy > Flashcards

2: Diabetic and HTN Retinopathy Flashcards

1
Q

What is diabetic retinopathy

A

progressive destruction of retinal microvasculature caused by chronic hyperglycaemia

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2
Q

What is the main cause of blindness in 25-65 year-olds

A

diabetic retinopathy

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3
Q

What are 3 risk factors for diabetic retinopathy

A

Age
Uncontrolled diabetes
HTN

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4
Q

what are 3 common symptoms of diabetic retinopathy

A

Blurred vision
Floaters
Sudden visual-loss

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5
Q

How can diabetic retinopathy be classified

A

Proliferative and Non-Proliferative diabetic retinopathy

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6
Q

How is non-proliferative diabetic retinopathy divided

A

Mild
Moderate
Sevre

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7
Q

What is 1 feature of mild non-proliferative diabetic retinopathy

A

1 or more micro aneurysms

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8
Q

What are the 6 features for moderate non-proliferative diabetic retinopathy

A
  1. Micro-aneurysms
  2. Blot haemorrhage (Flame-shaped haemorrhage)
  3. Hard exudates
  4. Cotton wool spots
  5. Venous loops
  6. Intra-retinal microvascular abnormality
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9
Q

What are the 3 features for severe non-proliferative diabetic retinopathy

A
  1. Micro-aneurysms in >4
    quadrants
  2. Venous bleed in >2 quadrants
  3. IRMA in one-quadrant
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10
Q

What is a more common type of retinopathy in T1DM

A

Proliferative diabetic retinopathy

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11
Q

What is risk of proliferative diabetic retinopathy

A

Neovascularisation increases risk of vitreous haemorrhage

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12
Q

What are the earliest sign of diabetic retinopathy

A

Micro-aneurysms

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13
Q

What are micro aneurysms

A

Dilations of capillary

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14
Q

How do micro aneurysms appear on fundoscopy

A

Red dots - often in clusters

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15
Q

What is a blot (or flame-shaped) haemorrhage also known as

A

Intra-retinal haemorrhage

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16
Q

What decides if an intra-retinal haemorrhage is called a blot or flame-shaped haemorrhage

A

Retinal depth

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17
Q

What is a flame-shaped haemorrhage

A

Superficial layer of retina

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18
Q

What is a blot haemorrhage

A

Deeper layer of retina

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19
Q

How do hard exudates appear on retinopathy

A

yellow patches

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20
Q

What causes hard exudates

A

extracellular lipids leaking from defective capillaries

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21
Q

Where are hard exudates more commonly found

A

by the macula

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22
Q

Explain venous loops

A

dilation and duplication of veins occurs as retina undergoes ischaemia

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23
Q

what is intra-retinal microvascular abnormalities (IRMA)

A

areas of new capillary formation that occurs secondary to retinal ischaemia

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24
Q

Explain neovascularisation

A

As retinal ischaemia occurs - new blood vessels arise

25
Q

How does neovascularisation present on fundoscopy

A

‘tufts’

26
Q

How can progression of diabetic retinopathy be classified

A
  1. Diabetes without retinopathy
  2. Non-proliferative DR
  3. Proliferative DR
27
Q

Explain diabetes without retinopathy

A

Hyperglycaemia causes damage to pericytes (cells responsible for surrounding blood vessels to control flow)

28
Q

What does damage to pericytes in non-proliferative DR cause

A
  1. Damage to pericytes causes weakening of capillaries leading to micro aneurysms
  2. Damage to pericytes increases permeability of capillaries enabling lipids to leak into retinal tissue causing hard exudates
29
Q

When does non-proliferative DR often onset after diagnosis

A

15-20 years

30
Q

Explain proliferative DR

A
  • Microvascular damage thus far causes retinal ischaemia
  • To compensate, retina releases VEGF
  • This increases proliferation of vessels
  • These vessels are insufficient to supply the retina and can lead to vitreous haemorrhage
31
Q

What other eye condition does diabetes increase the risk of

A

cataracts

32
Q

Why does diabetes increase the risk of cataracts

A

glucose is absorbed by the lens and converted to sorbitol where it precipitates

33
Q

If individuals have maculopathy, non-proliferative DR or proliferative DR how soon should they be reviewed by opthalmology

A

Urgently

34
Q

Explain screening for diabetes

A

Individuals are screened at diagnosis and annually thereafter

35
Q

How is screening for diabetic retinopathy performed

A

Dilated fundus photography

36
Q

Why is dilated fundus photography performed

A

to identify neovascularisation early to enable photocoagulation laser treatment

37
Q

When should individuals be referred to surgeons from diabetic retinopathy screening

A

if pre-proliferative retinopathy, proliferative, macuolopathy

38
Q

On diabetic eye-screening what is R0

A

No retinopathy

39
Q

On diabetic eye-screening what is R1

A

Mild non-proliferative retinopathy

40
Q

On diabetic eye-screening what is R2

A

Severe non-proliferative retinopathy

41
Q

On diabetic eye-screening what is R3

A

Proliferative retinopathy

42
Q

On diabetic eye-screening what is M0

A

No maculopathy

43
Q

On diabetic eye-screening what is M1

A

Maculopathy

44
Q

What is the treatment for diabetic retinopathy

A

Laser photocoagulation treatment

45
Q

What can be used in addition to laser photocoagulation treatment to treat diabetic retinopathy

A

Intra-vitreal triamcinolone or anti-VEGF

46
Q

What should also be controlled in diabetic retinopathy

A

BP: aim for less than 130/80

47
Q

What BP defines HTN

A

> 140/90

48
Q

What BP defines malignant HTN

A

> 220/120

49
Q

What classification is used for HTN retinopathy

A

Keith-Wegner

50
Q

Of the Keith-Wegner classification, what stages are usually seen in chronic HTN

A

Stage 1 and 2

51
Q

Of the Keith-Wegner classification, what stages are usually seen in malignant HTN

A

Stage 3 and 4

52
Q

What are the 3 signs of stage I keith-wegner HTN retinopathy

A
  1. AV narrowing and increases tortuosity
  2. Increased light reflex
  3. Sclerosis - causing silver wiring
53
Q

What is a sign of stage 2 ketih-wegner HTN retinopathy

A

AV nicking

54
Q

What is a sign of stage 3 Keith wegner HTN retinopathy

A

Cotton wool spots

Flame-shaped haemorrhages

55
Q

What is a sign of stage 4 Keith wegner HTN retinopathy

A

Papilloedema

56
Q

How may malignant HTN present

A

Headache, eye pain, reduced visual acuity

57
Q

What is the target BP if hypertensive retinopathy

A

<130/90

58
Q

if a diabetic has proteinuria what is the target BP

A

<125/75

59
Q

What visual conditions can HTN retinopathy pre-dispose to

A
  • Accelerates diabetic retinopathy
  • Retinal artery and vein occlusion
  • Vitreous haemorrhage
  • Papilloedema

Ophthalmology (12 decks)

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