Diabetic Eye Disease

Question 1

Common causes of LOV in diabetics

Answer 1

• cataract
• maculopathy
• vitreous haemorrhage
• tractional retinal detachment
• neovascular glaucoma

Question 2

What is maculopathy?

Answer 2

Any retinopathy between the temporal arcades

Question 3

How does pan-retinal photocoagulation work?

Answer 3

• burns the retina to ablate ischaemic tissue and reduce production of angiogenic factors

Question 4

Describe macular photocoagulation

Answer 4

• argon laser produces burns which allow absorption of oedema
• this stabilizes and improves vision
• small areas of leakage need focal laser
• large areas of leakage need grid laser

Question 5

Signs of non-proliferative retinopathy

Answer 5

• dot, blot and flame shaped haemorrhages
• microaneurysms
• hard exudates
• cotton wool spots
• intra-retinal microvascular abnormalities (IRMA)
• venous beading

Question 6

Danger signs of NPR

Answer 6

The HVI 4:2:1 rule

• harmorrhages in 4 quadrants or
• venous changes in 2 quadrants or
• IRMA in 1 quadrants

means severe ischaemia preceding proliferative changes

Question 7

What is the significance of hard exudates?

Answer 7

• indicate protein and lipid leakage
• if extensive, be concerned about lipid profile, BP and renal function
• severe hard exudates between fovea and disc suggest renal failure with nephrotic syndome

Question 8

When to refer for diabetic retinopathy

Answer 8

• any proliferative features (within 1 week)
• maculopathy or danger signs (within 1 month)
• other retinopathy (within months)

Question 9

What is rubeosis iridis?

Answer 9

New vessels grown on the iris

Question 10

What is the management of rubeosis iridis?

Answer 10

• urgent retinal laser is required to prevent neovascular glaucoma

Question 11

What causes a third nerve palsy in DR?

Answer 11

Microvasculopathy sparing outer pupillary nerve fibres

Question 12

What to do about a 3rd nerve palsey

Answer 12

if complete and pupil spared, watch for 6-12 weeks

if incomplete with pupil sparing, watch carefully for pupil involvement

if pupil involved, suspect aneurysm and refer for urgent angiogram

Question 13

Signs of mucormycosis

Answer 13

diabetes + ketoacidosis + proprosis

Question 14

Medical prevention of diabetic complications

Answer 14

• glucose maintained below 8
• BP kept below 160/90
• hyperlipidaemia tested for and treated in patients with maculopathy