diabetic retinopathy

Question 1

what is diabetic retinopathy?

Answer 1

-a condition where the blood vessels in the retina are damaged by prolonged exposure to high blood sugar (hyperglycaemia) causing a progressive deterioration in the health of the retina

Question 2

what effect does hyperglycemia have on retinal small vessels and endothelial cells?

Answer 2

• damages them leading to increased vascular permeability which causes leakage from the blood vessels, blot haemorrhages and the formation of hard exudates
• damage to blood vessel walls can also cause microaneurysms and venous beading

Question 3

what are blood vessel microaneurysms?

Answer 3

where weakness in the blood vessel wall causes small bulges

Question 4

what is venous beading of the blood vessels?

Answer 4

-where the walls of the veins are no longer straight and parallel and look more like string of beads or sausages

Question 5

what effect does hyperglycaemia have on nerve fibres in the eye?

Answer 5

-damages the nerve fibres in the retina causing fluffy white patches to form on the retina called cotton

Question 6

what are intraretinal microvascular abnormalities (IMRA)?

Answer 6

-is where there are dilated and tortuous capillaries in the retina. These can act as a shunt between the arterial and venous vessels in the retina

Question 7

what is neovascularisation?

Answer 7

-when growth factors are released in the retina causing the development of new blood vessels

Question 8

what are the types of diabetic retinopathy?

Answer 8

• non proliferative diabetic retinopathy

- proliferative diabetic retinopathy (neovasculature)

Question 9

describe the findings of mild non proliferative diabetic retinopathy

Answer 9

-microaneurysms

Question 10

describe the findings of moderate non proliferative diabetic retinopathy

Answer 10

• microaneurysms
• blot hemorrhages
• hard exudates
• cotton wool spots
• venous beading

Question 11

describe the findings of severe non proliferative diabetic retinopathy?

Answer 11

• blot haemorrhages
• microaneurysms in 4 quadrants
• venous bleeding in 2 quadrants
• intraretinal microvascular abnormality (IMRA) in any quadrant

Question 12

describe the findings of proliferative diabetic retinopathy?

Answer 12

• neovascularisation

- vitreus haemorrhage

Question 13

describe the findings of maculopathy?

Answer 13

• macular oedema

- ischaemic maculopathy

Question 14

what are the complications of diabetic retinopathy?

Answer 14

• retinal detachment
• vitreus haemorrhage (bleeding into the vitreus humour)
• rebeosis iridis (new blood vessel formation in the iris)
• optic neuropathy
• cataracts

Question 15

what is the management for diabetic retinopathy?

Answer 15

• laser photocoagulation
• anti VEGF meds (ranibizumab and bevacizumab)
• vitreoretinal surgery (keyhole surgery on the eye) in severe disease