Diabetic retinopathy

Question 1

important Diabetic retinopathy point

Answer 1

most common cause of blindness in adults aged 35-65yo

Question 2

pathophys of Diabetic retinopathy

Answer 2

hyperglycaemic causes:
-increased retinal blood flow
-abnormal metabolism in retinal vessel walls

this precipitaeas damage to endothelial cells and pericytes

Question 3

what does endothelial dysfunction in Diabetic retinopathy lead to

Answer 3

increased vascular permeability which causes characterisitc exudates seen on fundoscopy

Question 4

what does pericyte dysfunction in Diabetic retinopathy cause

Answer 4

formation of microaneurysms

Question 5

what causes neovasculatisation in Diabetic retinopathy

Answer 5

production of growth factors in response to retinal ischaemia

Question 6

what causes cotton wool spots in Diabetic retinopathy

Answer 6

damage to nerve fibres in the retina

Question 7

what causes venous beading and microaneurysms in Diabetic retinopathy

Answer 7

damage to blood vessels

Question 8

define microaneurysms

Answer 8

weakness in the wall causes small bulges

Question 9

define venous beading

Answer 9

walls of the veins are no longer straight and parallel and look more like a string of beads or sausages

Question 10

define intraretinal microvascular abnormalites

Answer 10

where there are dilated and tortuous capillaries in the retina

can act as a shunt between the arterial and venous vessels in the retina

Question 11

what are the 3 types of Diabetic retinopathy

Answer 11

non-prolieferative Diabetic retinopathy

proliferative Diabetic retinopathy

maculopathy

Question 12

state the criteria for mild non-proliferative diabetic retinopathy 1

Answer 12

1 or more microaneyrusm

Question 13

state teh criteria for moderate non-proliferative diabetic retinopathy 4

Answer 13

microaneyrms

blot haemorrhages

hard exudates

cotton wool spots

Question 14

state the criteria for severe non-proliferative diabetic retinopathy 3

Answer 14

blot haemorrhages and microaneurysm in 4 quadrants

venous beading in at least 2 quadrants

intraretinal microvascular abnormalties (IRMA)

Question 15

key features of proliferative diabetic retinopathy 3

Answer 15

retinal neovascularisation (may lead to citrous haemorrhage)

fiborus tissue forming anteriro to retinal disc

most common in type 1 DM (50% blind in 5 years )

Question 16

key features of maculopathy diabetic retinopathy 3

Answer 16

based on location rather than severity
-anything is potentially serious

hard exudates and other ‘background’ changes on macula

check visual acuity

more common in T2DM

Question 17

management of diabetic retinopathy 4

Answer 17

optimise glycaemic control, BP and hyperlipidemia

regular review by ophthalmology

Question 18

managedment of maculopathy diabetic retinopathy 1

Answer 18

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

Question 19

management of non-proliferative diabetic retinopathy 2

Answer 19

regular observation

if severe/ very severe consdier panretinal laser photocoagulation

Question 20

management for proliferative diabetic retinopathy 3

Answer 20

panretinal laser photocoagulation

intravitral VEGF inhbiotrs

if severe or vitreous haemorrhage
-vitreoretinal surgery