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Opthalmology > Diabetic Retinopathy > Flashcards

Diabetic Retinopathy Flashcards

1
Q

What is diabetic retinopathy?

A

Pathological breakdown of retinal vasculature due to persistent hyperglycaemia

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2
Q

Classifications of diabetic retinopathy?

A

A. Non-proliferative i. Background retinopathy ii. Maculopathy B. Proliferative diabetic retinopathy

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3
Q

What is background retinopathy?

A

Mild changes on opthalmoscopy (microaneurysms, small haemorrahges, hard exudates (not macula, but other parts of retina)) but no Sx or changes to vision

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4
Q

Rx of background retinopathy

A

Requires no immediate Rx except controlling BGL so it does not progress

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5
Q

What is maculopathy?

A

Oedema and exudates involving the macula * #1 cause of blindness in pts with diabetic retinopathy (does not even progress to worse form)

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6
Q

Sx of maculopathy

A

Blurring, decreased acuity, darkening, visual distortion

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7
Q

What is proliferative diabetic retinopathy?

A

More advanced stage of diabetic retinopathy, and is associated with poorer outcome. - Neovascularisation from optic disc or major vessels - Associated with vitreous haemorrhaging due to fragile vessels and tractional retinal detachment due to fibrosed vessels - Neovascular glaucoma can occur (vessels narrow the anterior angle)

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8
Q

What are microaneurysms?

A

The earliest clinical sign of diabetic retinopathy; these occur secondary to capillary wall outpouching due to pericyte loss; they appear as small, red dots in the superficial retinal layers

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9
Q

What are dot and blot haemorrhages?

A

Appear similar to microaneurysms if they are small; they occur as microaneurysms rupture in the deeper layers of the retina, such as the inner nuclear and outer plexiform layers

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10
Q

What are retinal oedema and hard exudates?

A

Caused by the breakdown of the blood-retina barrier, allowing leakage of serum proteins, lipids, and protein from the vessels

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11
Q

What are cotton wool spots (aka soft exudates)?

A

Nerve fiber layer infarctions from occlusion of precapillary arterioles; they are frequently bordered by microaneurysms and vascular hyperpermeability

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12
Q

What are flame-shaped haemorrhages?

A

Splinter hemorrhages that occur in the more superficial nerve fiber layer

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13
Q

What are venous loops and venous beading?

A

Frequently occur adjacent to areas of nonperfusion; they reflect increasing retinal ischemia, and their occurrence is the most significant predictor of progression to proliferative diabetic retinopathy (PDR)

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14
Q

What are the key fundoscopic signs of non-proliferative diabetic retinopathy?

A
  1. Haemorrhages: a. Dot-haemorrhage into the inner retinal areas b. Blot-haemorrahge into more superficial nerve fibre layers 2. Hard exudates have straight edges - leakage of protein and lipids from damaged capillaries 3. Soft exudates (cotton wool spots) have a fluffy appearnce owing to microinfarcts 4. Microaneurysms 5. Dilated veins
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15
Q

What are the signs of proliferative diabetic retinopathy?

A
  1. New vessels 2. Vitreous haemorrhage 3. Scar formation 4. Retinal detachment (oplalescent sheet that balloons forward into the vitreous) 5. Laser scars
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16
Q

Diabetic maculopathy is _____ and considered the more _____ form of non-proliferative DR (cf. ______) but does not necessarily progress into _________.

A

Diabetic maculopathy is symptomatic and considered the more advanced form of non-proliferative DR (cf. background DR) but does not necessarily progress into proliferative DR

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17
Q

Sx of diabetic maculopathy

A

Macula is affected: Loss of visual acuity Scotoma-like black spots in central vision Blurred vision Image distortion esp. relative to other eye

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18
Q

Dx of diabetic maculopathy

A

Opthalmoscopic exam Optical coherence tomography

19
Q

2 causes of diabetic maculopathy

A
  1. Macular oedema - Leakage of fluid into foveal tissue - Lipid exudates adjacent to fovea 2. Macular ischaemia - Capillary non- perfusion at fovea - Enlarged foveal avascular zone and capillary drop-out on fluorescein angiography
20
Q

What is the management for macular oedema?

A

For diabetic macular oedema: -Macular (grid) laser -Intra-vitreal - Anti-VEGF agents

21
Q

What is the management for macular ischaemia?

A

-No specific treatment for macular ischaemia -Blood sugar level control -Blood pressure control -Cholesterol control

22
Q

How do we grade NPDR?

A

Grading -Mild NPDR -Moderate NPDR -Severe NPDR -Very Severe NPDR

23
Q

When is NPDR graded as ‘mild NPDR’?

A

Mild NPDR: 1. Microaneurysms

24
Q

When is NPDR graded as ‘moderate NPDR’?

A

Moderate NPDR: 1. Microaneurysms 2. Intra-retinal haemorrhages 3. Hard exudates 4. Cotton wool spots

25
Q

When is NPDR graded as ‘severe NPDR’?

A

Severe NPDR: any 1 feature of the 4:2:1 rule In the most severe stage of NPDR, you will find cotton wool spots, venous beading, and severe intraretinal microvascular abnormalities (IRMA). It is diagnosed using the “4-2-1 rule.” A diagnosis is made if the patient has any of the following: 1. diffuse intraretinal hemorrhages and microaneurysms in 4 quadrants 2. venous beading in ≥2 quadrants, or 3. IRMA in ≥1 quadrant

26
Q

When is NPDR graded as ‘very severe’?

A

2 features from the 4-2-1 rule

27
Q

What is proliferative diabetic retinopathy (PDR)?

A

Most advanced stage of DR where native vessels have endured damage to the point where new vessels form

28
Q

List the classification of PDR

A
  1. Low risk PDR 2. High risk PDR
29
Q

What are the main characteristics of low risk PDR?

A
30
Q

What are the main characteristics of high risk PDR?

A
  • disc neovascularised (NVD) plus vitreous haemorrhage - NVD >one third of the disc - NVE (neo-vascularisation everywhere!)
31
Q

What is vitreous haemorrhage?

A

Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye

32
Q

What are the complications of continued vascular proliferation?

A

a. Glaucoma: New vessels may progress to the anterior structures and block the angle of the eye which would lead to glaucoma
b. Retinal detachment: vessels contract and dead vascular tissue can fibrose and act as a tractional point (when turning the eye with movement) for retinal detachment

33
Q

Sx of PDR

A

Blurred vision (can be from vitreous haemorrahge or macular oedema) - Floaters (blood in vitreous) - Difficulty w/ night time vision

34
Q

Management of PDR

A

1st line: Pan-retinal photocoagulation (retinal laser): - Goal: create 2,000 burns in retina with hope of reducing retina’s O2 demand in the peripheries and therefore ischaemia - Burns used to destroy the abnormal BVs in periphery

  • Decreases drive of VEGF production, leading to reduced neo-vascularisation
  • Peripheral vision sacrificed
  • Reduces severe vision loss (centre preserved)
35
Q

Dx of PDR

A

Opthalmoscopic examination Ocular tonometry if shows signs of glaucoma (measure IOP)

36
Q

What does this show?

A

Early diabetic changes in eyes (background retinopathy)

37
Q

What does this show?

A

Optical coherence tomography (OCT) in patient with diabetic maculopathy

38
Q

What does this show?

A

NPDR maculopathy

39
Q

What does this show?

A

PDR with venous loops and new vessels

40
Q

What does this show?

A

PDR with vitrious haemorrahge

41
Q

What does this show?

A

PDR

42
Q

What does this show?

A

Panretinal photocoagulation

43
Q

Why do people with diabetes go blind?

A
  1. Diabetic maculopathy
  2. Glaucoma - neovascularization complication
44
Q
A

Opthalmology (5 decks)

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