Diabetes III

Question 1

Describe in detail the different types of diabetic retinopathy [3]

Answer 1

Question 3

Describe the three classifications of diabetic retinopathy? [2]

Answer 3

non-proliferative diabetic retinopathy (NPDR) marked by:
- microaneurysms
- retinal haemorrhages (dot haemorrhages)
- hard exudates (yellowish deposits of lipid due to vessel leakage)

proliferative diabetic retinopathy (PDR) (more advanced and severe stage), is characterized by:
- the proliferation of new, fragile blood vessels that can bleed into the vitreous, leading to vision loss due to VEGF upregulation
- can be new vessels on disc (NVD) OR new vessels everywhere (NVE)

Diabetic maculopathy:
- Presence of any retinopathy within 1 disc diameter around macula:
Can be:
- Focal
- Diffuse
- Ischaemic

Question 4

How can PDR lead to blindness? [4]

Answer 4

• New blood vessels are very fragile; easily break and leak
• Retinal haemorrhage can lead to acute blindness
• If repeated; leads to fibrosis & scarring
• Can lead to: tractional retinal detachment: when scar tissue or other tissue grows on your retina and pulls it away from the layer underneath

Question 5

Which pathology is depicted? [1]

Answer 5

Diabetic maculopathy: hard exudates near to the macula

Question 6

What is depicted in this image? [1]

Answer 6

Proliferative diabetic retinopathy:
extensive vitreous haemorrhage obscuring most of fundus (white circle)}

Question 7

What is the arrow pointing to? [1]

Answer 7

Cotton wool spot

Cotton wool spots appear as grayish/whitish spots with soft, fuzzy edges, giving them a resemblance to a ball of cotton wool. They do not usually appear in clusters like hard exudate.

Question 8

What is depicted in this image? [1]

Answer 8

Non-proliferative diabetic retinopathy: blot haemorrhage (white circle)}

Question 9

Describe what is happening in this image [1]

Answer 9

Proliferative diabetic retinopathy: NVD new vessels on the optic disc

Question 10

What is the management of diabetic retinopathy? [5]

Answer 10

Laser photocoagulation

Anti-VEGF medications such as ranibizumab, bevacizumab & Aflibercept

Vitreoretinal surgery (keyhole surgery on the eye) may be required in severe disease or a vitrectomy may be necessary to clear severe vitreous hemorrhage or to relieve tractional retinal detachment.

Corticosteroids (triamcinolone, dexamethasone implant) can also be used, particularly in refractory DME.

Pan-retinal photocoagulation (PRP): laser used to make small burns evenly across the peripheral retina - should make blood vessels shrink and dissapear

Question 11

Name this sign [1] and disease [1] that is a complication of diabetes

Answer 11

Prayer sign; diabetic cheiroarthropathy

Question 12

The following term describes which sign of diabetic retinopathy

Damaged vessels may rupture and leak blood.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Answer 12

The following term describes which sign of diabetic retinopathy

Damaged vessels may rupture and leak blood.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Question 13

The following term describes which sign of diabetic retinopathy

transient, small, whitish opacities with feathery edges located within the superficial retina and represent microinfarctions of small retinal arteriole

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Answer 13

The following term describes which sign of diabetic retinopathy

transient, small, whitish opacities with feathery edges located within the superficial retina and represent microinfarctions of small retinal arteriole

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Question 14

The following term describes which sign of diabetic retinopathy

Deposits of lipids that have leaked onto the retina through damaged vessels.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Answer 14

The following term describes which sign of diabetic retinopathy

Deposits of lipids that have leaked onto the retina through damaged vessels.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Question 15

The following term describes which sign of diabetic retinopathy

“Out-pouching” results from weakened capillary walls. The earliest visible clinical sign of diabetic retinopathy.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Answer 15

The following term describes which sign of diabetic retinopathy

“Out-pouching” results from weakened capillary walls. The earliest visible clinical sign of diabetic retinopathy.

Venous beading
Cotton wool spots
Hard exudates
Dot and blot haemorrhages
Microaneurysms

Question 16

What is the most common cause of visual loss in patients with diabetes? [1]

Describe this [1]

Answer 16

Diabetic macular oedema (DMO)

DMO is the commonest cause of visual loss in patients with diabetes

DMO is characterised by oedematous changes in or around the macula. As the macula is responsible for central vision, affected patients tend to complain of blurred vision when reading or difficulty recognising faces in front of them. DMO is the commonest cause of visual loss in patients with diabetes.9

Question 17

DMO can be subcategorised into three categories. Describe them [3]

Answer 17

Focal/diffuse macular oedema:
* the fluid that escapes from damaged vessels can be well-circumscribed (focal) or more widespread and poorly demarcated in nature (diffuse).

Ischaemic maculopathy:
- patients will be symptomatic with defects in visual acuity due to ischaemia at the site of the macula. These areas are best visualised with fluorescein angiography.

Clinically significant macular oedema (CSMO):
- CSMO describes significant changes associated with retinopathy, such as hard exudates and retinal thickening, found within a certain distance to the fovea or greater than a certain size.

Question 18

What is the name of this treatment for diabetic retinopathy? [1]

Answer 18

Pan-retinal photocoagulation (PRP)

Question 19

Name this complication of diabetic retinopathy [1]

Answer 19

Diabetic retinopathy is one of several causes of neovascular glaucoma: a type of secondary glaucoma.

Neovascularization can occur within the iris and its trabecular meshwork (rubeosis) causing a narrowing and closure of the drainage angle and therefore increased intraocular pressure.

Question 20

What level of diabetic retinopathy does it suggest? [1]

Answer 20

New vessels on disc
- Proliferative DR

Question 21

What level of diabetic retinopathy does it suggest? [1]

Answer 21

Microaneursym
- Non-proliferative DR

Question 22

What level of diabetic retinopathy does it suggest? [1]

Answer 22

New vessels everywhere:
- PDR

Question 23

What level of diabetic retinopathy does it suggest? [1]

Answer 23

Dot & Blot haemorrhages - NPDR

Question 24

Answer 24

Diabetic maculopathy