Common Medical Retinal Conditions

Question 1

diabetic retinopathy

• a serious complication of diabetes . often reflects severe vascular disease elsewhere in body . essentially a disease of small vessels of retina. vascular disease can take form of leakage or closure or both - and resultant ischaemia*
• -*two kinds (2)

what is diabetic maculopathy

Answer 1

-background retinopathy

>common when diabetes has been present for several years.

-proliferative retinopathy

>background retinopathy may progress to this. it is more serious and site threatening

-diabetic maculopathy is a special form of retinopathy that can occur with either background or proliferative retinopathy

Question 2

background retinopathy

signs on inspection of fundus. (5) when is vision affected (1)

Answer 2

• micraneurysms. often temporal side of macula and post pole of fundus
• vision affected is microaneurysms clustered around macula region and leak fluid. results in oedema
• exudates. tend to form rings around areas of diseased vessels full ring may not be visible. these are yellowish-white deposits with fine edges which are the result of leaked lipoproteins.
• capiliary dilation subtle sign
• haemorrhages - can be small, large or flame shaped.
• cotton woll spots. greyish-white with poor defined edges. they are accumulations that occur around infarct of retinal nn layer

Question 3

-preproliferative retinopathy

> occurs in poorly controlled diabetes . warning signs for proliferative retinopathy (approx 50% will progress to proliferative) signs on inspection of fundus (3).

Answer 3

• large dark blot haemorrages
• beading of retinal veins - irregular calibre and dilation
• -*intraretinal microvascular abnormalities - new vessels of retina or optic disc

Question 4

proliferative retinopathy

• occurs in 5% diabetics. site threatening
• signs on inspection of fundus

Answer 4

• new vessels / neovascularisation of optic nn or retina - these occur as a response to retinal ischaemia - they appear as small tufts that ramify irregularly . may be flat initially but can move into vitreous cavity as they grow ew
• may see acute preretinal (i assume this is just infront of retina) or vitreous haemorrage due to neovascularisation leakage.
• retinal fibrosis late stage
• traction retinal detachment late stage
• neovascular glaucoma late stage

Question 5

diabetic maculopathy

• commonest cause of visual impairment in diabetic pt . what are the three types of diabetic maculopathy
• image shows retinal and macular oedema*

Answer 5

• focal. caused by focal leakage of a microaneurysm or dilated capiliary. surrounding exudates are seen. image shows focal maculopathy with exudates
• diffuse retinal oedema. caused by diffuse leakage from dilated capiliaries at post pole of eye. this results oedema over macular. may be associated with aneurysms and haemorrages but exudates not present
• ischaemic maculopathy - caused by closure of capilliary network surrounding the macular and fovea. diffuse oedema and several dark haemorrages seen. might need fluorescein angiograhy to confirm iachemia and severity image pto

Question 6

diabetic retinopathy - mx (4)

image shows ischaemic maculopathy

Answer 6

-control diabetes EDUCATE PT

-laser photocoagulation see image - used for preproliferative, proliferative and sometimes maculopathy .

>focused light beam is used to cauterise affected areas of retina. thought that photocoagulation of ischaemic areas prevents further proliferation.

-glaucoma surgery may be needed for neovascular glaucoma

-vitreo retinal surgery may be able to remove haemorrge