Diabetes 1

Question 1

Who is most likely to get diabetes

Answer 1

south asian
obese

rough figures of UK- 3.9%- 2.5million people

Question 2

What is Diabetic retinopathy

Answer 2

A diabetic microangiopathy affecting retinal blood vessels

due to poor metabolic control. could lead to progressive retinal damage -complete visual loss????

Question 3

Who does diabetic retinopathy effect?

Answer 3

Both type 1 and type 2.
Highest among young px with type 1
However more px have type2- therefore more px with DR and type 2
not as common if secondary diabetes
common cause of blindness in working population

Question 4

What are the risk factors for diabetic retinopathy

Answer 4

poor metabolic control
hypertension?
longer duration of the disease
type 1 diabetes- all px develop some after 10-15 years
LDL choloseterol
pregnancy
aneamia
smoking???

Question 5

What can Microangiopathy- Capillary Occlusion lead to?

Answer 5

a- Microvascular occlusion- Cotton wool spots, neovas, arteriovenous shunts, capillary closure
b- Microvascular leakage- exudates, odeama, haemorrhages

Question 6

What are micro aneurysms

Answer 6

Small red dots- 20-200um

The earliest detectable change in DR

Question 7

What can happen with micro aneurysms

Answer 7

They can
self resolve- half disappear within 3 years
rupture- hemmorages
occlude- infarction- cotton wool spots
leak- exudates/odeama

Question 8

What are exudates

Answer 8

Yellow waxy layeres
Between inner plexiform and inner nucleus layers
due to leakage of lipoproteins from the capillaries

Question 9

What are haemorrhages

Answer 9

Bleed

• Dot and blot haemorrhages from the venous end of the capillaries- and in compact middle layers.
• Flame shaped haemorrhages originate from superficial pre capillary arterioles and follow the NFL

Question 10

Whats background retinopathy

Answer 10

Early changes associated with DR-
not on macular- non sight threatening
u may see a few micro-aneurysms, haemorrhages, exudates and cotton wool spots.

Question 11

Whats maculopathy

Answer 11

Leakage of retinal fluid around the fovea.
sight threatening complication
can also see micro-aneurysms/exudates/hemamohrages

Question 12

What are the types of maculopathy

Answer 12

Focal- due to focal leakage from micro-aneurysms and capillaries
Diffuse- leakage from capillaries around the posterior pole- can cause diffuse macular odeama- difficult to treat as diffuse
Ischeamic- hypo perfusion of macular- decreased blood flow

Question 13

What’s a cotton wool spot

Answer 13

Retinal micro infarcts as a consequence of retinal ischeamia

Question 14

Whats pre- proliferative retinopathy?

Answer 14

From retinal ischaemia
more than 5 cotton wool spots
sight threatening
venous irregularities- beeding, duplication and loops
heamorages
intre-retinal microvascular abnormalities

Question 15

What does venous beading show

Answer 15

retinal ischeamia

Question 16

INTRA RETINAL MICROVASCULAR ABNORMALITIeS

Answer 16

IRMA- AV shunts

Question 17

What’s prolifertaive retinopathy

Answer 17

From retinal hypoperfusion
Sight thearening
neovasculirsation- could get new blood vessels on disc NVD and NVE new blood vessels elsewhere
pre retinal or subhyloid heammohrages- looks like a boat- louis style
fibrous tissue

Question 18

Advanced diabetic eye disease

Answer 18

Sight is compromised
vitreous heammorage
fibrous tissue
rd?
rubeosis iridis- new blood vessels on iris
neovascular glaucoma

Question 19

Catracts and diabetes.

Answer 19

Develops at an earlier age
quite common
And faster if diabetes is uncontrolled
the osmotic lens opacity is reversible
and if needs be- can’t see fundus- lots of light scatter during laser therapy-
then cataract surgery- u need optimal diabetes control- STABLE DIABETES
More complications- difficult due to smaller pupils? also iritis, raised iop, delayed wound healing

Question 20

POst operative care for diabetic cataracts

Answer 20

inflammation more likely
DR may detorriate due to surgery- particularly macular odeama
px need to be seen day after op
post eye drops? steroids/ anti inflammatory

Question 21

With diabetes what happens to the iris?

Answer 21

Iris transillumination? loss of pigment behind iris- can see cells in ac. not serious but shows lack of control of diabetes
Iris rubeosis- new vessel growth into iris and AC angle- due to ischeamia- could cause neovas glaucoma as BV can occlude TM
can treat with pan-laser and
use anti vegf drugs

Question 22

Diabetes and cornea

Answer 22

Minor probs
diaebtic keratopathy
Contraindication of cl wear
loss of sensitivity- increased chance of corneal erosions/ ulcers
more fragile epithelium

Question 23

Diabetic conjuctiva

Answer 23

can see microaneuryms- usually harmless- warning at risk of DR

Question 24

Cranial 3rd nerve palises and diabetes

Answer 24

3rd nerve palsy
caused by microangiography
pupil dilation
limited movement
may have ptosis
however with diabetes-may be partial- i.e. pupil not always involved
recovers within 6 months

IF PAINFUL- REFER URGENT- as could be intracranial aneurysm

Question 25

Diabetes and 6th nerve palsy

Answer 25

cannot abduct

Question 26

Management of diplopia

Answer 26

path
prisms
see an orthoptist
refer to hosp
if secondary to diabetes- revers well within 6months

Question 27

Mucormycosis of Orbit-

Answer 27

fatal fungal infection
gets through nose
for type 1 young px