Diabetic retinopathy Flashcards
which age range is it the most common cause of blindness
35-65 years old
pathophysiology
hyperglycaemia increases retinal blood flow and abnormal metabolism In the retinal vessel walls
causes damage to the endothelial cells nd pericytes
leads to vascular permeability
causes cexudates 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
classification
Non-proliferative diabetic retinopathy
Proliferative diabetic retinopathy
Maculopathy
What is non-proliferative diabetic retinopathy?
classified mil-severe
Mild NPDR
1 or more microaneurysm
Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots (‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
features of proliferative diabetic retinopathy
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM,
features of maculopathy
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM
Mx all patents
optimise glycaemic control, blood pressure and hyperlipidemia
regular review by ophthalmology
Mx of maculopathy
if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors
Mx of non-proliferative retinopathy
regular observation
severe - pan retinal laser photocoagulation
Mx of proliferative retinopathy
panretinal laser photocoagulation
intravitreal VEGF inhibitors e.g. ranibizumab
if severe or vitreous haemorrhage: vitreoretinal surgery
