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ENT, neuro, eyes > Diabetic and hypertensive retinopathy > Flashcards

Diabetic and hypertensive retinopathy Flashcards

1
Q

Which condition are cotton wool spotsa major feature of

A

Hypertensive retinopathy

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2
Q

What condition are microaneurysms only seen in?

A

Diabetes

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3
Q

What is diabetic retinopathy?

A

is a result of microvascular damage caused by hyperglycaemia.

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4
Q

How does diabetes cause retinopathy

A

Increased blood glucose levels -> structural occlusions, leaks, inflammation, hypoxia retinal capillaries
Cascade via VEGF -> neovascu;aristation

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5
Q

What do microaneursyms appear on fundoscopy

A

Little dots, change colour in inner retinal layers

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6
Q

What does VEGFdo?

A

Signalling protein that responds to ischaemia, hypoxia adn inflammation
Alters capillary permeability -> oedema from vascular leakage, neovascularisation

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7
Q

Why does neovascularisation cause bleeding?

A

The new vessels are fragile as they’re abnormal

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8
Q

What does rupture of neovascular vessels cause?

A

Subhyaloid haemorrahges, vitreous haemorrhage
Fibrose -> retinal detactchment
Iridis - new vessels Block drainage nagle -> raised IOCP
Rubeotic glaucoma

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9
Q

What is diabetic maculopathy?

A

Changes occuring in central - fovea or macular regions due to diabetes

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10
Q

What are Intraretinal microvascular abnormalities

A

Collateral between arterious and venous systems
Healthy vessels

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11
Q

Investigation for neovascularisation

A

Intravenous fluorescein angiography

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12
Q

Symptoms diabetic maculopathy

A

Gradual deterioration of visual acuity, central blurrines

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13
Q

Why are exudates rings?

A

Leakage form microaneurysms

At edge of area f oedema

AS leakage spreads in all directions in plane of retina, get ring of exudate

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14
Q

Early changes on fundoscopy of background retinopatyh

A
  • Microaneuysms
  • Dot and blot haemorrhages
  • Oedema
  • Exudates
    • Yellow
    • Rings
    • Distinct margins
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15
Q

Fundoscopy of pre-proliferative diabetic retinopathy

A

Alongside early changes
- Larger blot haemorrages
- Venous dilation, beading and loops
- Cotton wol spots
- Paler and more fluffy than exudates
- Waste products of axonal transport
- Form when ischaemic damage to nerve fibre layer preventing usual transport
- IRMAs = Intra-Retinal microvascular abnoramlitis
- Collateral vessels in response to occlusion

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16
Q

Fundoscopy of proliferative diabetic retinopathy

A

Neovascularisation on the disc = NVD

Elsewhere = NVE

Retina and iris = rubeosis iridis

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17
Q

Complications of proliferative diabetic retinopathy

A

Sub hyaloid haemorrhage
Vitreous haemorrhage
Reubeosis Iridis

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18
Q

What is sub hyaloid haemorrhage

A

Bleed into space between retina andvitroeus = sub-hyaloid space

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19
Q

What is vitreous haemorrhage?

A

-Vessels can grow into vitrous - moves vitreous suddenly may tear vessels →haemorrhage into it

20
Q

What is reubeosis iridis?

A

Neovascularisation onto iris

21
Q

What is tractional retinal detatchment?

A

New vessels fibrose -> irreplacable vision loss in some cases

22
Q

Treatment for diabetic retinopathy

A

aser treatment: focal or pan-retinal photocoagulation

Anti-VEGF injections

Intra-vitreal steroids

Vitrectomy

23
Q

Whcih stage of diabetic retinopathy do yuo treat?

A

Pre-proliferative as preventative, proliferative as treatment

24
Q

What is Pan-retinal Photocoagulation adn what does it do?

A
  • Reduce ischaemia by lasering the peripheral retina - reduce area of tissue requiring oxygen
  • Shrinks new vessels
  • Do not laser macular region - would cause central vision loss
25
Side effect of pan retinal photcoagulation
loose peripheral vision - Affects ability to drive - Before - totally asymptomatic
26
Wh\t does antiVGEF do
Revereses effects of VEGF
27
Risk and benefots anit VEGF
- PRP is safe and reliable + requires fewer appointments for patient - Risk of endophthalmitis - potenitally blinding eye infection - Regular intervals injections needed - Very expensive
28
What treatment cna't be performed through vitreous haemorrhage
Panretinal photocoagulation
29
Vitreous haemorrhage treatment
Most self resolve Then PRP OR Vitrectomy - removing vitreous surgically and replacing with fluid
30
What does vitrectomy do?
- Clears blood - Removes reservoir for VGED - Laser treatment can then be performed
31
Treatment of maculopathy
Focal laser of microaneurysms
32
Why don't always offer anit veg F
Any intra-ocular injection carries a risk of endophthalmitis a potentially sight threatening infection 2  Laser treatment is usually a one-off treatment , but patients need a regular series of injections to keep the oedema and exudation at bay, potentially for years. 3  Anti-VEGF injections are expensive at the moment, costing around £800 a shot.
33
What can use in adjunct with focal laser treatment?
anti VEGF
34
Benefits and risks of intra-vitral steroids
- Macular oedema - Reduce inflammation, VGEF and vascular leakage - Long acting implants injected into eye - Can cause cataract and glaucoma
35
Investigations
IV fluroescin angiography Optical coherence tomography
36
How does a IVFA wokr
Fluroscein dye IV injection → systemic → choroidal and retinal vessels Fluoresces at certain light frequncey, deteceted Larger leak, brighter picture Very safe
37
How does Opitcal coherence tomography work
Refraction of different wavelengths of light → cross section image of retina. or en face or 3D Safe, non invasive, no radiation
38
What change in diabetes can cause a deterioration in retinopathy
Rapid imporvement i control of diabetes Pregnancy Monitor T2DM switched to insulin
39
Prevention of diabetic retinopathy
Screening aged 12 and pver Diabetes control HPTN control Renal function Anaemia Lipids Obesity, smoking Pregnancy - retinopathy can progress very rapdily Monitored much more frequently to give timely treatment
40
Risk factors for HPTNsive retinopathy
- African caribean > caucasian - Women > men - Smoking - Co-exisintg renal disease
41
How do renal vessels vary from noraml and significance
- Absence of sympathetic nerve supply - Autoregulation of blood flow - Presence of blood-retinal barrier Means HPTN directly transfered to vessels
42
Malignant HPTN changes
Severely raised BP Headaches, visual loss Swollen optic discs and exudation
43
When is HPTN retinopathy diagnosed
Central vein occlusion
44
Features of HPTN retinopathy
Flame shaped haemorrhages Cotton wool spots
45
Treatment of HPTNsive retinopathy
Causes of HPTN To treat venous occlusions + macular oedema + precent revascularisation -anti-VGEF -Intra-vitreal steroids -Panretinal photo

ENT, neuro, eyes (34 decks)

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