Diabetic Retinopathy Flashcards
What are the risk factors for diabetic retinopathy?
- Hypertension
- Ethnicity
- Obesity
- Diet
- Diabetes duration
- Smoking
What are the two classification of diabetic retinopathy?
- Non-Proliferative DR
- Proliferative DR
What is the pathogenesis of Non-Proliferative DR?
- For NPDR:
- Extended hyperglycaemia causes damage to the vascular endothelial (loss of pericytes + basement membrane thickening)
- Leukocytes adhere to capillary wall causing capillary occlusion.
What is the pathogenesis of Proliferative Diabetic Retinopathy?
- Extended ischaemia releases VEGF promoting new blood vessels which are weak and bleed leading to hamorrhages (cotton wool spots, neovascularisation, venous beading)
What is the pathogenesis of diabetic macular oedema?
- Chronic inflammation + endothelial damage causes increased vascular permeability -> more microaneurysms and exudates
What are the signs with their releveant grading of NPDR and PDR?
R1: Microaneurysms, retinal haemorrhages. hard exudates, cotton wool spot, venous looping.
R2: All above + venous beading, IRMA, blot haemorrhages
R3A: All above + NVD, NVE, vitreous haemorrhages, traction retinal detachment
R3S: All above + laser scars, stable old ‘new’ vessels
What is the referral for diabetic retinopathy?
R1: Monitor every 6 months
R2: Urgent referral with screning scheme
R3A; Emergency Referral with screening scheme
R3S: Monitor every 6 months
What are the investigations for px with diabetic retinopathy?
- FFA
- OCT
- H&S
- Slit lamp
What are the treatments for diabetic retinopathy?
R1: Lifestyle Advice
R2: Monitor every 6 months, assess diabetic control. lifestyle advice, FFA
R3A: Laser PRP and could do vitrectomy
DMO: Anti-VEGF (ranibuzimab + afilbercept) or corticosteroids (dexamethasone implant)
What is the differential diagnosis of DR?
- Hypertensive Retinopathy
