Diabetic Retinopathy

Question 1

Is diabetic retinopathy a microvascular or macrovascular complication?

Answer 1

Microvascular

Question 2

What is diabetic retinopathy?

Answer 2

Progressive damage to the retina’s blood vessels due to chronic hyperglycaemia.

Question 3

What is the leading cause of blindness ina adults worldwide?

Answer 3

Diabetic retinopathy

Question 4

Diabetic retinopathy can be divided into what 2 primary stages?

Answer 4

1) non-proliferative diabetic retinopathy (NPDR)

2) proliferative diabetic retinopathy (PDR)

Question 5

What is NPDR marked by?

Answer 5

• microaneurysms
• retinal haemorrhages
• hard exudates

Question 6

What is PDR marked by?

Answer 6

proliferation of new, fragile vessels that can bleed into the vitreous, leading to vision loss.

Question 7

NPDR can be further classified further into mild, moderate, and severe, based on the clinical findings.

What is found in mild NPDR?

Answer 7

Presence of at least one microaneurysm.

Question 8

What is found in moderate NPDR?

Answer 8

• more extensive microaneurysms
• haemorrhages
• hard exudates
• cotton wool spots on retina

Question 9

What are cotton wool spots on the retina?

Answer 9

Areas of nerve fibre layer infarctions

Question 10

What is found in severe NPDR?

Answer 10

Defined by the ‘4:2:1’ rule.

There are either:
- more than 20 intraretinal haemorrhages in each of 4 quadrants (4)
- definite venous beading in 2 or more quadrants (2), or
- prominent intraretinal microvascular abnormalities (IRMA) in 1 or more quadrant (1).

Question 11

What is PDR?

Answer 11

Advanced stage of disease, marked by growth of new blood vessels (neovascularisation) due to widespread retinal ischaemia.

These new vessels are fragile and prone to leaking, which can lead to complications such as vitreous haemorrhage and tractional retinal detachment.

Question 12

How can PDR be further subdivided?

Answer 12

Based on the extent and location of the neovascularisation and associated complications:

1) Early PDR
2) High-risk PDR

Question 13

Describe early PDR

Answer 13

New vessels less than 1/3 of the disc area, no vitreous haemorrhage, and no tractional retinal detachment.

Question 14

Describe high risk PDR

Answer 14

Characterised by any of the following:

• neovascularisation of the disc (NVD) greater than or equal to 1/3 of the disc area
• any NVD associated with vitreous or preretinal haemorrhage, or
• neovascularization elsewhere (NVE) greater than or equal to 1/2 disc area with vitreous or preretinal haemorrhage.

Question 15

What is diabetic macular oedema (DME)?

Answer 15

A complication of diabetic retinopathy, can occur at any stage.

Occurs when fluid and protein deposits collect on or under the macula, causing it to thicken & swell (oedema).

Question 16

What is the most common cause of vision loss in people with diabetic retinopathy?

Answer 16

Diabetic macular oedema

Question 17

Clinical features of diabetic retinopathy?

Answer 17

• asymptomatic in early stages
• blurred vision
• floaterrs
• dark areas in visual field
• vision loss

Question 18

Fundoscopy signs in diabetic retinopathy?

Answer 18

• microaneurysms
• haemorrhages
• hard exudates
• cotton wool spots
• venous beading
• intraretinal microvascular abnormalities (NPDR)
• neovascularisation (PDR)
• vitreous/preretinal haemorrhage (PDR)

Question 19

What is the 1ary goal in mx of diabetic retinopathy?

Answer 19

Preventing progression & preserving vision.

This involves optimal control of blood sugar levels, blood pressure, and lipid

Question 20

What is the mainstay of treatment for PDR & diabetic macular oedema?

Answer 20

Laser photocoagulation

Question 21

Mx options in diabetic retinopathy?

Answer 21

1) Laser photocoagulation (PDR & DME)

2) Anti-VEGF therapy (PDR & DME)

3) Steroids (refractory DME)

4) Vitrectomy in severe cases