Diabetic Retinopathy Flashcards
A 63-year-old gentleman presents to his GP for an annual blood pressure review. He is poorly compliant with medications. His current regime includes ramipril 5mg OD, amlodipine 10mg OD, and doxazosin 1mg OD.
He has recently been diagnosed with type II diabetes mellitus and has been started on metformin. His ECG shows left ventricular hypertrophy and direct ophthalmoscopy demonstrates AV nipping, silver wiring and a few cotton wool spots in the peripheral retina.
Based on the direct ophthalmoscopy findings, which of the following best describe this patient’s retinal pathology?
A Pre-proliferative diabetic retinopathy B Background diabetic retinopathy C Macula oedema D Grade II hypertensive retinopathy E Grade III hypertensive retinopathy
This patient is suffering from hypertensive retinopathy grade III.
The classification of this condition is shown below:
Grade I - Silver wiring (sclerosis of vessels).
Grade II - Arteriovenous nipping (compression of a vein at an arteriovenous crossing).
Grade III - Cotton wool spots (ischaemic areas) and haemorrhages.
Grade IV - Papilloedema (swollen optic disc).
Patients with diabetic retinopathy may get cotton wool spots. However, this patient has only recently been diagnosed with type II diabetes, and the absence of other diabetic eye features such as ‘dot and blot’ haemorrhages and hard exudates makes this diagnosis less likely.
