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Year 4 Ophthalmology > Diabetic retinopathy > Flashcards

Diabetic retinopathy Flashcards

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
Management of pre proliferative diabetic nephropathy
Follow up every 4 months and observe
26
High risk proliferative diabetic retinopathy
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
Types of diabetic maculopathy
``` Focal Diffuse Ischaemia Mixed CSMO - clinically significant macular oedema Central involving ```
28
Focal diabetic maculopathy features
Well circumscribed areas of leakage with oedema Full or partial ring of hard exudates surrounding a microaneursym region
29
Treatment of focal diabetic maculopathy features
Focal laser
30
Diffuse diabetic maculopathy features
Diffuse retinal thickness with cystoid oedema
31
Treatment of diffuse diabetic maculopathy
Grid laser
32
Investigations for diabetic maculopathy
Fundoscopy OCT - optical coherence tomography Fundus fluorescein angiography (FFA)
33
Features of ischaemic diabetic maculopathy
Reduced visual acuity Normal clinical appearance Macular ischaemia on fundus fluorescein angiography (FFA)
34
Management of ischaemic diabetic maculopathy
Observe
35
CSMO
Clinically significant macular oedema
36
CSMO features
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
Mixed diabetic maculopathy features
Combination of diffuse and ischaemic diabetic maculopathy
38
Central involving diabetic maculopathy
Thickening involving the fovea centre > 400 micron
39
Treatment for central involving diabetic maculopathy
``` Anti VEGF injection IV iluvien (steroid) for persistent diabetic maculopathy ```
40
Complications of diabetes on eye
``` 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
Treatment of vitreous haemorrhage
Pan retinal photocoagulation same day or within 2 weeks Persistent - vitrectomy + endolaser + anti VEGF
42
Treatment of Rubeosis
Urgent pan retinal photocoagulation Anti VEGF Intra ocular pressure reduction - cyclodiode
43
Ruberiosis
New blood vessel formation in iris

Year 4 Ophthalmology (27 decks)

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