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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
Q

Side effect of pan retinal photcoagulation

A

loose peripheral vision
- Affects ability to drive
- Before - totally asymptomatic

26
Q

Wh\t does antiVGEF do

A

Revereses effects of VEGF

27
Q

Risk and benefots anit VEGF

A
  • PRP is safe and reliable + requires fewer appointments for patient
  • Risk of endophthalmitis - potenitally blinding eye infection
  • Regular intervals injections needed
  • Very expensive
28
Q

What treatment cna’t be performed through vitreous haemorrhage

A

Panretinal photocoagulation

29
Q

Vitreous haemorrhage treatment

A

Most self resolve
Then PRP
OR
Vitrectomy - removing vitreous surgically and replacing with fluid

30
Q

What does vitrectomy do?

A
  • Clears blood
  • Removes reservoir for VGED
  • Laser treatment can then be performed
31
Q

Treatment of maculopathy

A

Focal laser of microaneurysms

32
Q

Why don’t always offer anit veg F

A

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
Q

What can use in adjunct with focal laser treatment?

A

anti VEGF

34
Q

Benefits and risks of intra-vitral steroids

A
  • Macular oedema
  • Reduce inflammation, VGEF and vascular leakage
  • Long acting implants injected into eye
  • Can cause cataract and glaucoma
35
Q

Investigations

A

IV fluroescin angiography
Optical coherence tomography

36
Q

How does a IVFA wokr

A

Fluroscein dye IV injection → systemic → choroidal and retinal vessels

Fluoresces at certain light frequncey, deteceted

Larger leak, brighter picture

Very safe

37
Q

How does Opitcal coherence tomography work

A

Refraction of different wavelengths of light → cross section image of retina. or en face or 3D
Safe, non invasive, no radiation

38
Q

What change in diabetes can cause a deterioration in retinopathy

A

Rapid imporvement i control of diabetes
Pregnancy
Monitor T2DM switched to insulin

39
Q

Prevention of diabetic retinopathy

A

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
Q

Risk factors for HPTNsive retinopathy

A
  • African caribean > caucasian
  • Women > men
  • Smoking
  • Co-exisintg renal disease
41
Q

How do renal vessels vary from noraml and significance

A
  • Absence of sympathetic nerve supply
  • Autoregulation of blood flow
  • Presence of blood-retinal barrier
    Means HPTN directly transfered to vessels
42
Q

Malignant HPTN changes

A

Severely raised BP
Headaches, visual loss
Swollen optic discs and exudation

43
Q

When is HPTN retinopathy diagnosed

A

Central vein occlusion

44
Q

Features of HPTN retinopathy

A

Flame shaped haemorrhages
Cotton wool spots

45
Q

Treatment of HPTNsive retinopathy

A

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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