Diabetic retinopathy

Question 1

Pathophysiology of diabetic retinopathy?

Answer 1

Hyperglycaemia is thought to cause 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

Question 2

classification of diabetic retinopathy ?

Answer 2

Non-proliferative diabetic retinopathy

Proliferative diabetic retinopathy

Maculopathy

Question 3

classification in Non-proliferative diabetic retinopathy?

Answer 3

Mild NPDR

Moderate NPDR

Severe NPDR

Question 4

classification of mild NPDR?

Answer 4

1 or more microaneurysm

Question 5

classification of moderate NPDR?

Answer 5

microaneurysms

blot haemorrhages

hard exudates

cotton wool spots (‘soft exudates’ - represent areas of retinal infarction),

venous beading/looping

intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Question 6

classification of severe NPDR?

Answer 6

blot haemorrhages and microaneurysms in 4 quadrants

venous beading in at least 2 quadrants

IRMA in at least 1 quadrant

Question 7

classification of Proliferative diabetic retinopathy

Answer 7

retinal neovascularisation - may lead to vitrous haemorrhage

fibrous tissue forming anterior to retinal disc

Question 8

Proliferative diabetic retinopathy more common in ?

Answer 8

more common in Type I DM, 50% blind in 5 years

Question 9

Maculopathy more common in ?

Answer 9

Type II DM

Question 10

Maculopathy based on ?

Answer 10

location rather than severity

Question 11

features of maculopthy ?

Answer 11

hard exudates and other ‘background’ changes on macula
check visual acuity

Question 12

managemt of all diabetic retinopathy ?

Answer 12

optimise glycaemic control, blood pressure and hyperlipidemia

regular review by ophthalmology

Question 13

managemt of diabetic maculopathy ?

Answer 13

change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors

Question 14

mx of Non-proliferative retinopathy

Answer 14

regular observation

if severe/very severe consider panretinal laser photocoagulation

Question 15

mx of proliferative retinopathy

Answer 15

panretinal laser photocoagulation

intravitreal VEGF inhibitors - now used in combination with panretinal laser photocoagulation
examples include ranibizumab
slow progression of proliferative diabetic retinopathy and improve visual acuity

Question 16

if severe or vitreous haemorrhage in Proliferative retinopathy?

Answer 16

vitreoretinal surgery

Question 17

Complication of DM opthalmologically?

Answer 17

Optic neuritis
decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma