Diabetic retinopathy Flashcards
What is diabetic retinopathy?
A microvascular complication of diabetes, caused by hyperglycaemia-induced damage to the retinal blood vessels
What are the 3 stages of diabetic retinopathy?
Background retinopathy - microaneurysms develop in the retinal blood vessels
Pre-proliferative retinopathy - widespread changes including flame haemorrhages and cotton wool spots
Proliferative retinopathy - scar tissue and new blood vessels form, risk of retinal detachment
What are the risk factors for diabetic retinopathy?
Poor glycaemic control
Length of diabetes diagnosis
Hypertension
Renal dysfunction
Pregnancy
Dyslipidaemia
What is the pathophysiology of diabetic retinopathy?
Hyperglycaemia damages the retinal small vessels and endothelial cells
Increased vascular permeability leads to leaking blood vessels, blot haemorrhages and hard exudates
Damage to blood vessel walls leads to microaneurysm and venous bleeding
Damage to nerve fibres in the retina causes fluffy white patches called cotton wool spots
What are the symptoms of diabetic retinopathy?
May be asymptomatic
Blurred vision
Loss of colour vision
Floaters
Sudden vision loss
What will be seen on fundoscopy in diabetic retinopathy?
Microaneurysms
Dot and blot haemorrhages
Hard exudates
Cotton wool spots
Neovascularisation
What are the investigations used in diagnosis of diabetic retinopathy?
Ophthalmoscopy
Optical coherence tomography
Fluorescein angiography
What are the complications of diabetic retinopathy?
Vision loss
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis
Optic neuropathy
Cataracts
What is the management of diabetic retinopathy?
Diabetic control
Lifestyle modifications
For proliferative disease:
- Pan-retinal photocoagulation - extensive laser treatment across the retina
- Anti-VEGF agents - used to reduce macular oedema and neocascularisation
- Steroid injections
- Vitrectomy
