Diabetic retinopathy Flashcards
Why does it happen?
What else does diabetes increase the risk of?
Visual symptoms which are seen in advanced stages
Diabetic microvascular damage
Increased risk of cataracts and glaucoma
Blurred vision
Floaters
Visual loss
Signs on fundoscopy:
The earliest sign is small red dots. What do these dots suggest?
This progresses to dot and blot haemorrhages. What causes this?
Why do you get hard exudates? - think about prev 2 q’s
Why do you see cotton wool spots?
What may happen to the venules in the retina?
What is IMRA?
Microaneurysms
Rupture of the aneurysms
Lipid and protein leak from vessels
Ischaemia of the retinal nerve fibres
Venous beading (dilation) and looping - due to retinal ischaemia
Intraretinal microvascular abnormalities - remodelled capillary beds
Classification:
2 types
Non-proliferative retinopathy (NPDR) Proliferative retinopathy (PDR)
Non-proliferative retinopathy (NPDR):
What determines severity
How is it different from proliferative?
Early signs:
How would the following look like on fundoscopy?
- microaneurysms
- haemorrhages
- hard exudates
Later signs - 3
What can NPDR progress to?
Degree of ischaemia
Dots Flame shaped or 'blots' Yellow patches ---- Engored tortuous veins Cotton wool spots Large blot haemorrhages
PDR
Proliferative retinopathy (PDR):
How is this different from NPDR?
What might you see because of the above?
Symptoms of the previous Q?
What is tractional retinal detachment?
Neovascularisation
Vitreous haemorrhage due to fine new vessels in the retina and optic disc
Floaters
flashes
Sudden loss of vision
When scar tissue or other tissue grows on your retina and pulls it away from the layer underneath. It can lead to serious vision loss. This type is often found in people with diabetes who have severe diabetic retinopathy, or damage to blood vessels in the retina.
Maculopathy:
Why do you get this?
Why is this relevant?
Is the visual loss sudden or gradual?
Leakage of the vessels close to the macula causing oedema and significantly threatens vision.
Can occur with both NDPR and PDR
Gradual
Investigations:
What is done for all newly diagnosed diabetics?
What can be used to look at the extent of macular oedema?
What can be used to assess leak from fragile new vessels in PDR?
Screening and oedema - annual retinal photography with pupillary dilation
Optical coherence tomography
Fluorescein angiography
Management:
Unaffected diabetics and patients with NPDR:
- What 2 things need to be controlled in order to prevent the development or progression of DR?
PDR with vitreous haemorrhage or extensive neovascularisation:
- What can be done?
- Why is a vitrectomy done?
Glucose
BP - end-organ damage
Panretinal laser photocoagulation
Vitreous haemorrhage persisting > 6 months OR tractional retinal detachment
Management:
Macular oedema:
Aflibercept, ranibizumab and bevacizumab are used for this. What type of drug are these?
What else can be done for it?
Intravitreal anti-VEGF drugs
Focal laser photocoagulation
