diabetic retinopathy

Question 1

describe the pathophysioology of diabetic retinopathy

Answer 1

Hyperglycaemia leads to increased retinal blood flow and abnormal metabolism in the retinal vessel walls

precipitates damage to endothelial cells and pericytes

endothelial dysfunction leads to increased vascular permeability which causes the characteristic exudates seen on fundoscopy.

Pericyte dysfunction predisposes to the formation of microaneurysms.

Neovasculization is thought to be caused by the production of growth factors in response to retinal ischaemia

Question 2

describe the classification of diabetic retinopathy

Answer 2

1. non-proliferative diabetic retinopathy (NPDR)
2. proliferative retinopathy (PDR)
3. maculopathy.

Question 3

describe the general management of diabetic retinopathy

Answer 3

All patients
optimise glycaemic control, blood pressure and hyperlipidemia
regular review by ophthalmology

Question 4

describe the management of diabetic retinopathy - maculopathy

Answer 4

if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors

Question 5

describe the management of diabetic retinopathy non-proliferative retinopathy

Answer 5

regular observation
if severe/very severe consider panretinal laser photocoagulation

Question 6

describe the management of diabetic retinopathy proliferative retinopathy

Answer 6

panretinal laser photocoagulation
intravitreal VEGF inhibitors
often now used in combination with panretinal laser photocoagulation
examples include ranibizumab
strong evidence base suggests they both slow progression of proliferative diabetic retinopathy and improve visual acuity
if severe or vitreous haemorrhage: vitreoretinal surgery