Diabetic eye disease Flashcards
What is diabetic retinopathy?
Diabetic retinopathy is the most common cause of blindness in adults aged 35-65 years-old.
What causes damage in diabetic retinopathy?
Hyperglycaemia causes increased retinal blood flow and abnormal metabolism in the retinal vessel walls, leading to endothelial cell and pericyte damage.
What is the classification of diabetic retinopathy?
Patients are classified into non-proliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy.
What are the features of mild non-proliferative diabetic retinopathy?
Mild NPDR is characterized by 1 or more microaneurysms.
What are the features of moderate non-proliferative diabetic retinopathy?
Moderate NPDR includes microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading, and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR.
What are the features of severe non-proliferative diabetic retinopathy?
Severe NPDR includes blot haemorrhages and microaneurysms in 4 quadrants, venous beading in at least 2 quadrants, and IRMA in at least 1 quadrant.
What are the key features of proliferative diabetic retinopathy?
Key features include retinal neovascularisation, fibrous tissue forming anterior to the retinal disc, and a high risk of blindness in Type I DM.
What are the key features of maculopathy?
Maculopathy is based on location rather than severity, with hard exudates and other background changes on the macula.
What is the management for all diabetic retinopathy patients?
Management includes optimizing glycaemic control, blood pressure, and hyperlipidemia, along with regular ophthalmology reviews.
What is the treatment for maculopathy if there is a change in visual acuity?
Intravitreal vascular endothelial growth factor (VEGF) inhibitors.
What is the management for severe non-proliferative retinopathy?
Regular observation; if severe/very severe, consider panretinal laser photocoagulation.
What is the management for proliferative retinopathy?
Panretinal laser photocoagulation and intravitreal VEGF inhibitors, often used in combination.
What is diabetic maculopathy?
Diabetic maculopathy is macular oedema caused by leakage of vessels close to the macula, threatening vision.
What are the fundoscopy signs of proliferative diabetic retinopathy?
New blood vessels can be found on the retina or optic disc.
What are the fundoscopy signs in severe non-proliferative diabetic retinopathy?
Signs include engorged tortuous veins, cotton wool spots, and large blot haemorrhages.
What are the fundoscopy signs in mild non-proliferative diabetic retinopathy?
Signs include dots (microaneurysms), hard exudates (lipid deposits), and blots (haemorrhages).
What is the pathophysiology of cotton wool spots in diabetic retinopathy?
Cotton wool spots represent areas of retinal infarction due to pre-capillary arteriolar occlusion.
What feature is not present in diabetic pre-proliferative retinopathy?
Neovascularisation is not present in diabetic pre-proliferative retinopathy.
What is the likely underlying pathology causing cotton wool spots?
Cotton wool spots are caused by retinal infarction.
