diabetic retinopathy Flashcards
who is diabetic retinopathy seen in?
Diabetic retinopathy is the most common cause of blindness in adults aged 35-65 years-old.
pathophysiology?
Hyperglycaemia is thought to cause increased retinal blood flow and abnormal metabolism in the retinal vessel walls. This precipitates damage to endothelial cells and pericytes
Endothelial dysfunction leads to increased vascular permeability which causes the characteristic exudates 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
classifications?
Non-proliferative diabetic retinopathy
Proliferative diabetic retinopathy
Maculopathy
what is Mild NPDR
1 or more microaneurysm
what is 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
what is severe NDPR?
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
features of proliferative?
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years
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 of all pts?
optimise glycaemic control, blood pressure and hyperlipidemia
regular review by ophthalmology
mx maculopathy?
if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors
mx NPDR?
regular observation
if severe/very severe consider panretinal laser photocoagulation
mx proliferative?
panretinal laser photocoagulation
intravitreal VEGF inhibitors
if severe or vitreous haemorrhage: vitreoretinal surgery
