Diabetic Retinopathy

Question 1

What is Diabetic Retinopathy?

Answer 1

Condition where retina blood vessels damaged bc hyperglycaemia –> progressive deterioration to retina health

Question 2

What are the different Pathophysiology concepts that lead to Diabetic retinopathy? (5 things)

Answer 2

1. Vascular permeability
2. Microaneurysms + Venous beading
3. Nerve fibre damage
4. Intraretinal Microvascular Abn (IrMA)
5. Neovascularisation

Question 3

How does Vasc permeability lead to damage in Diabetic Retinopathy? (4 steps)

Answer 3

1. Hyperglycaemia
2. Damage to Retina small vessels + Endothelial cells
3. Increased vasc permeability
4. Leakage from blood vessels + Blot haemorrhages + Hard exudate formation

Question 4

What are Hard exudates?

Answer 4

Yellow / white lipid deposits in retina

Question 5

How do you get Microaneurysms and Venous beading in Diabetic Retinopathy? (2 steps)

Answer 5

1. Damage to blood vessel walls
2. Microaneursyms + Venous beading

Question 6

What are Microaneursyms?

Answer 6

Weakness in vessel wall –> small bulges

Question 7

What is Venous beading? (2 things)

Answer 7

1. Walls of veins no longer straight + parallel
2. Veins look more like string of beads / sujuk

Question 8

What does Nerve fibre damage lead to in Diabetic Retinopathy?

Answer 8

Cotton wool spots (fluffy white patches on retina)

Question 9

What is Intraretinal Micovascular Abn (IrMA)? (2 things)

Answer 9

1. Dilated + Tortuous capillaries in retina
2. Capillaries act as shunt between arterial + venous vessels in retina
   (Tortuous = beh twists n turns)

Question 10

What is Neovascularisation?

Answer 10

Growth factors released in retina –> dev new blood vessels

Question 11

What are the different types of Diabetic Retinopathy? (2 things)

Answer 11

1. Non-proliferative
2. Proliferative

Question 12

What does the classification of Diabetic Retinopathy depend on?

Answer 12

Whether new blood vessels have developed
(seen on fundoscopy)

Question 13

What are some other names for Non-proliferative, and why is it called that?

Answer 13

• Background / Pre-proliferative retinopathy
• Bc can develop into Proliferative

Question 14

What are the CF of MILD Non-proliferative Diabetic Retinopathy?

Answer 14

Microaneurysms

Question 15

What are the CF of MODERATE Non-proliferative Diabetic Retinopathy? (5 things)

Answer 15

1. Microaneurysms
2. Blot haemorrhages
3. Hard exudates
4. Cotton wool spots
5. Venous beading

Question 16

What are the CF of SEVERE Non-proliferative Diabetic Retinopathy? (4 things)

Answer 16

1. Microaneurysms (in 4 quadrants)
2. Blot haemorrhages (in 4 quadrants)
3. Venous beading (in 2 quadrants)
4. Intraretinal Microvascular Abn (IrMA) (in any quadrant)

Question 17

What are the CF of SEVERE Non-proliferative Diabetic Retinopathy? (4 things)

Answer 17

1. Microaneurysms (in 4 quadrants)
2. Blot haemorrhages (in 4 quadrants)
3. Venous beading (in 2 quadrants)
4. Intraretinal Microvascular Abn (IrMA) (in any quadrant)

Question 18

What are the CF of Proliferative Diabetic Retinopathy? (2 things)

Answer 18

1. Neovascularisation
2. Vitreous haemorrhage

Question 19

What are the Mx options for Diabetic Retinopathy? (3 things)

Answer 19

1. Laser photocoagulation
2. Anti-VEGF meds (bevacizumab)
3. Vitreoretinal surgery (keyhole surgery) (if severe)

Question 20

What are some examples of Anti-VEGF? (2 things)

Answer 20

1. Ranibizumab
2. Bevacizumab

Question 21

What are the complications of Diabetic Retinopathy? (5 things)

Answer 21

1. Retinal detachment
2. Optic neuropathy
3. Vitreous haemorrhage (bleeding into vitreous humour)
4. Rebeosis iridis (new blood vessel formation in Iris)
5. Cataracts