Diabetic Retinopathy

Question 1

What is diabetic retinopathy

Answer 1

Chronic damage to retinal blood vessels due to prolonged high blood sugar levels

Question 2

Pathophysiology of diabetic retinopathy

Answer 2

Hyperglycaemia -> damage to blood vessels and nerves -> increased vascular permeability -> leaky vessels -> hard exudates and blot haemorrhages formation in retina

Damage to blood vessels also leads to neovascularisation, and intraretinal microvascular abnormalities

Question 3

Complications of diabetic retinopathy

Answer 3

Vision loss
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis
Optic neuropathy
Cataracts

Question 4

What is the grading for diabetic retinopathy?

What signs would you see for each on fundoscopy?

Answer 4

Background - microaneurysms, retinal haemorrhage, hard exudate, cotton wool spots

Pre - proliferative - venous beading, multiple blot haemorrhages and IMRA

Proliferative - neovascularisation, vitreous haemorrhage

Question 5

How is diabetic maculopathy different?

Management of diabetic maculopathy?

Answer 5

On fundoscopy see macula exudates and macular oedema

Management - intravitreal dexamethasone implant

Question 6

Management of diabetic retinopathy

Answer 6

Non proliferative DR - close monitoring, diabetic control

Proliferative DR - Pan-retinal photocoagulation, intravitreal anti VEGF injections, vitrectomy