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Year 4 Ophthalmology > Diabetic retinopathy > Flashcards

Diabetic retinopathy Flashcards

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1
Q

Diabetic retinopathy

A

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

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2
Q

Pathophysiology of diabetic retinopathy

A

Hyperglycaemia leads to damage to the retinal small vessels and endothelial cells.

Increased vascular permeability:

  • leakage from the blood vessels
  • blot haemorrhages
  • the formation of hard exudates

Damage to blood vessels:

  • microaneurysms
  • venous beading
  • Intraretinal microvascular abnormalities (IMRA)

Damage to nerves:

  • cotton wool spots
  • Neovascularisation
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3
Q

Hard exudates

A

Yellow/white deposits of lipids in the retina

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4
Q

Microaneurysms

A

Weakness in the wall causes small bulges

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5
Q

Venous beading

A

Walls of the veins are no longer straight and parallel and look more like a string of beads or sausages

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6
Q

Cotton wool spots

A

Damage to nerve fibres in the retina causes fluffy white patches

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7
Q

Intraretinal microvascular abnormalities (IMRA)

A

Dilated and tortuous capillaries in the retina.

Can act as a shunt between the arterial and venous vessels in the retina

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8
Q

Neovascularisation

A

Growth factors are released in the retina causing the development of new blood vessels.

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9
Q

Classification of diabetic retinopathy

A

Non-proliferative (pre-proliferative)

  • mild
  • moderate
  • severe

Proliferative

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10
Q

Proliferative diabetic retinopathy

A

New blood vessels developed - Neovascularisation at disc or within 1 DD of disc

Vitreous haemorrhage

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11
Q

Diabetic maculopathy

A

Separate to diabetic retinopathy

Causes:

  • Macular oedema
  • Ischaemic maculopathy
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12
Q

Mild non-proliferative Diabetic Retinopathy

A

Microaneurysms

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13
Q

Moderate non-proliferative Diabetic Retinopathy

A

Microaneurysms and at least 1 of:

  • Blot haemorrhages
  • Hard exudates
  • Cotton wool spots
  • Venous beading
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14
Q

Severe non-proliferative Diabetic Retinopathy (4-2-1 rule)

A

Blot haemorrhages plus microaneurysms in 4 quadrants

Venous beading in 2 quadrates

Intraretinal microvascular abnormality (IMRA) in any quadrant

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15
Q

Complications of diabetic retinopathy

A

Retinal detachment

Vitreous haemorrhage (bleeding in to the vitreous humour)

Rebeosis iridis

Optic neuropathy

Cataracts

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16
Q

Rebeosis iridis

A

New blood vessel formation in the iris

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17
Q

Management of proliferative diabetic retinopathy

A

Laser photocoagulation within 2 weeks - pan-retinal photocoagulation (PRP)

2 week follow up

Anti-VEGF medications such as ranibizumab and bevacizumab

Vitreoretinal surgery (keyhole surgery on the eye) may be required in severe disease

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18
Q

Risk factors for diabetic retinopathy

A 
Long duration of diabetes 
Uncontrolled diabetes 
Hypertension 
Nephropathy 
Pregnancy 
Smoking 
Obesity
19
Q

Why is there increased capillary leakage

A

Loss of pericytes

20
Q

What causes occlusion of retinal arteries

A

Basement membrane thickening
Endothelial damage
RBC changes - rouleaux formation
Increased platelet aggregation

21
Q

Rouleaux formation

A

Linking of RBCs into chains resembling stacks of coins

22
Q

Background diabetic nephropathy

A

Microaneurysms
Blot haemorrhages
Hard exudate
Cotton wool spots

23
Q

Management of background diabetic haemorrhage

A

Follow up every 9 months and observe

24
Q

Pre proliferative diabetic nephropathy

A 
Intraretinal microvascular aneurysms 
Venous looping
Venous beading 
Cluster of large blot haemorrhages 
Multiple cotton wool spots
25
Q

Management of pre proliferative diabetic nephropathy

A

Follow up every 4 months and observe

26
Q

High risk proliferative diabetic retinopathy

A

Neovascularistaion (NVD) of more than 1/3rd of disc
or any with vitreous haemorrhage

Or neovascularisation elsewhere (NVE) of more than 1/2 disc area

27
Q

Types of diabetic maculopathy

A 
Focal 
Diffuse 
Ischaemia
Mixed 
CSMO - clinically significant macular oedema 
Central involving
28
Q

Focal diabetic maculopathy features

A

Well circumscribed areas of leakage with oedema

Full or partial ring of hard exudates surrounding a microaneursym region

29
Q

Treatment of focal diabetic maculopathy features

A

Focal laser

30
Q

Diffuse diabetic maculopathy features

A

Diffuse retinal thickness with cystoid oedema

31
Q

Treatment of diffuse diabetic maculopathy

A

Grid laser

32
Q

Investigations for diabetic maculopathy

A

Fundoscopy
OCT - optical coherence tomography
Fundus fluorescein angiography (FFA)

33
Q

Features of ischaemic diabetic maculopathy

A

Reduced visual acuity

Normal clinical appearance

Macular ischaemia on fundus fluorescein angiography (FFA)

34
Q

Management of ischaemic diabetic maculopathy

A

Observe

35
Q

CSMO

A

Clinically significant macular oedema

36
Q

CSMO features

A

Retinal thickening at or within 500 microns of the centre of the macula

Hard exudates at/within 500 microns of the centre of the macula - associated with adjacent retinal thickening

Retinal thickness of > 1 disc area, any part of which within 1DD of the centre of the macula

37
Q

Mixed diabetic maculopathy features

A

Combination of diffuse and ischaemic diabetic maculopathy

38
Q

Central involving diabetic maculopathy

A

Thickening involving the fovea centre > 400 micron

39
Q

Treatment for central involving diabetic maculopathy

A 
Anti VEGF injection 
IV iluvien (steroid) for persistent diabetic maculopathy
40
Q

Complications of diabetes on eye

A 
Retinopathy 
Iridopathy 
Unstable refraction 
Orbital infection 
Ocular ischaemic syndrome 
Recurrent stye or chalazion 
Accelerated senile cataract 
Neovascular glaucoma (NVG) 
Oculomotor nerve palsy 
Reduced corneal sensitivity 
Papillopathy - optic nerve pathology 
Tractional retinal detachment
41
Q

Treatment of vitreous haemorrhage

A

Pan retinal photocoagulation same day or within 2 weeks

Persistent - vitrectomy + endolaser + anti VEGF

42
Q

Treatment of Rubeosis

A

Urgent pan retinal photocoagulation

Anti VEGF

Intra ocular pressure reduction - cyclodiode

43
Q

Ruberiosis

A

New blood vessel formation in iris

Year 4 Ophthalmology (27 decks)

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