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Year 3 > Diabetic eye disease (E&M) > Flashcards

Diabetic eye disease (E&M) Flashcards

1
Q

Define diabetic retinopathy.

A

Chronic progressive retinal manifestation of hyperglycaemic vascular damage and neurodegenerative change

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2
Q

What is diabetic retinopathy the main cause of? (2)

A
  • visual loss in people with diabetes
  • blindness in people of working age
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3
Q

What is the main mechanism of diabetic retinopathy?

A

Endothelial dysfunction and retinal ischaemia –> produces factors that increase leakiness –> may lead to macular oedema and neovascularisation (due to EPO production)

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4
Q

What are the two types of diabetic retinopathy?

A
  • non-proliferative (early stage, less severe, moderate visual loss)
  • proliferative (more advanced, severe visual loss)
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5
Q

Who does diabetic retinopathy affect?

A
  • eventually occurs to some degree in all patients with DM
  • most common cause of visual impairment and blindness in patients aged 25-74
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6
Q

What is the progression of diabetic retinopathy? (4)

A
  • background retinopathy
  • pre-proliferative retinopathy
  • proliferative retinopathy
  • maculopathy
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7
Q

How can you classify diabetic retinopathy? (5)

A
  • no disease visible
  • mild non-proliferative diabetic retinopathy (NPDR) - localised swelling of small vessels in retina (microaneurysms)
  • moderate NPDR - mild NPDR + small bleeds (dot and blot haemorrhages), leaks (hard exudates) or closure (cotton wool spots) of small blood vessels
  • severe NPDR - moderate NPDR + further damage to blood vessels (interetinal haemorrhages, venous beading, intraretinal microvascular abnormalities)
  • PDR - new vessel formation or vitreous/preretinal haemorrhage or tractional retinal detachment
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8
Q

What are the clinical features of diabetic retinopathy? (5)

A
  • asymptomatic until very late stages - screening important
  • spots/dark strings floating in vision
  • blurred vision
  • fluctuating vision
  • vision loss
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9
Q

What are the features of non-proliferative diabetic retinopathy? (4)

A
  • microaneurysms
  • hard exudates
  • blot haemorrhages
  • cotton wool spots
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10
Q

What are the features of proliferative diabetic retinopathy? (3)

A
  • non-proliferative features (microaneurysms, hard exudates, blot haemorrhages, cotton wool spots)
  • retinal neovascularisation
  • retinal detachment
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11
Q

What can cause complete vision loss? (2)

A
  • retinal detachment
  • vitreous haemorrhage
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12
Q

What are the features of retinal detachment (causes complete vision loss)? (3)

A
  • sudden painless loss of vision
  • dense shadow starting peripherally and progressing centrally
  • flashers/floaters (vs vitreous haemorrhage has no flashing lights)
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13
Q

What are the features of vitreous haemorrhage (causes complete vision loss)? (3)

A
  • bleeding into vitreous humour
  • sudden appearance of spots/floaters - blurred vision
  • no flashing lights like in retinal detachment
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14
Q

What are fundoscopy findings of background retinopathy? (3)

A
  • (mild NPDR)
  • microaneurysms (red dots)
  • blot haemorrhages (leaky vessels)
  • hard exudates (cheese-coloured lipid deposits due to leakage)
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15
Q

What are the fundoscopy findings of pre-proliferative retinopathy? (3)

A
  • (moderate/severe NPDR)
  • features of background retinopathy (microaneurysms, blot haemorrhages, hard exudates)
  • cotton wool spots AKA soft exudates (larger yellow spots - retinal ischaemia)
  • haemorrhages
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16
Q

What are the fundoscopy findings of proliferative retinopathy? (2)

A
  • features of NPDR (microaneurysms, blot haemorrhages, hard exudates, cotton wool spots)
  • neovascularisation (disc/elsewhere)
  • (fibrous tissue forming anterior to retinal disease)
  • (vision loss due to retinal detachment)
  • (vitreous haemorrhage)
17
Q

What are the fundoscopy findings of maculopathy?

A

Background retinopathy (hard exudates/oedema) but near macula –> can threaten vision

18
Q

What is the difference between moderate and severe non-proliferative retinopathy? (5)

A
  • both have blot haemorrhages + hard exudates (severe:)
  • microaneurysms in 4 quadrants
  • venous beading in 2+ quadrants
  • intraretinal microvascular abnormalities in 1+ quadrant
  • cotton wool spots (soft exudates)
19
Q

What are the risk factors for diabetic retinopathy? (5)

A
  • longer duration of diabetes
  • poor glycaemic control
  • elevated lipid levels (high cholesterol)
  • hypertension
  • pregnancy
20
Q

What are the 1st-line investigations for diabetic retinopathy? (4)

A
  • fundoscopy (fundus photography)
  • optical coherence tomography
  • fluorescein angiography
  • B-scan ultrasonography
21
Q

What are some differential diagnoses for diabetic retinopathy? (4)

A
  • ocular ischaemic syndrome
  • radiation retinopathy
  • retinal venous occlusion
  • hypertension
22
Q

How do we generally manage diabetic retinopathy in all patients? (4)

A
  • improve blood glucose
  • improve BP control
  • improve serum lipid control
  • regular review by opthalmology
23
Q

What is the 1st-line management for background retinopathy?

A

Annual surveillance + improve glycaemic control

24
Q

What is the 1st-line management for (severe) pre-proliferative retinopathy? (2)

A
  • pan-retinal photocoagulation (using laser to burn new vessels that form - preventative but can cause black dots on retina)
  • if severe/vitreous haemorrhage: vitreoretinal surgery
25
Q

What is the 1st-line management for proliferative retinopathy? (2)

A
  • pan-retinal photocoagulation (laser)
  • intravitreal anti-VEGF therapy
26
Q

What is the 1st-line management for diabetic maculopathy? (2)

A
  • anti-VEGF (evastin - for oedema)
  • grid laser therapy
27
Q

What is the 1st-line management for cataracts (diabetic retinopathy)? (2)

A
  • NSAIDs and corticosteroids
  • pan-retinal photocoagulation before cataract surgery
28
Q

What are some complications of diabetic retinopathy? (6)

A
  • vitreous haemorrhage
  • retinal detachment
  • glaucoma
  • blindness
  • cataract
  • macular oedema
29
Q

Describe the prognosis of diabetic retinopathy.

A

Chronic progressive disease; visual loss may develop despite treatment

Year 3 (145 decks)

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