Diabetic Retinopathy

Question 1

What is diabetic retinopathy?

Answer 1

Condition where blood vessels in retina are damaged by prolonged exposure to increased blood sugar levels
-This exposure can cause progressive deterioration of retinal health

Question 2

What does hyperglycaemia lead to?

Answer 2

Damage of retinal small vessels & endothelial cells
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Increased vascular permeability leads to leakage from blood vessels, blot haemorrhages & formation of hard exudates (white lipid deposits on retina)
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Damage to blood vessel walls lead to microaneurysms & venous bleeding (where walls of veins look like a string of beads)

Question 3

What is the cause of cotton wool spots?

Answer 3

Damage to nerve fibres in the retina (causing these fluffy white patches to form on the retina)

Question 4

What does IMRA stand for?

Answer 4

Intra-retinal microvascular abnormalities

Question 5

What are IMRAs?

Answer 5

When there are dilated & torturous capillaries in retina

-These can act as a shunt between arterial & venous vessels in retina

Question 6

What is neovascularisation?

Answer 6

Growth factors are released in retina causing development of new blood vessels

Question 7

The 4 pathophysiology features of diabetic retinopathy?

Answer 7

Microaneurysms
Cotton wool spots
IMRA
Neovascularisation

Question 8

2 broad categories of diabetic retinopathy?

Answer 8

Non-proliferative

Proliferative

Question 9

What do the categories depend on?

Answer 9

Whether new blood vessels have developed

Question 10

Describe non-proliferative retinopathy?

Answer 10

Often called background/ pre-proliferative retinopathy as it can develop to proliferative retinopathy

Question 11

Findings on a fundus examination in mild non-proliferative?

Answer 11

Microaneurysms

Question 12

Findings on a fundus examination in moderate non-proliferative?

Answer 12

Microaneurysms 
Blot haemorrhages 
Hard exudates 
Cotton wool spots 
Bleeding

Question 13

Findings on a fundus examination in severe non-proliferative diabetic retinopathy?

Answer 13

Blot haemorrhages plus microaneurysms in 4 quadrants

• Venous beating in 2 quadrates
• Intra-retinal microvascular abnormalities (IMRA) in any quadrant

Question 14

Examination findings on a fundus in proliferative retinopathy?

Answer 14

Neovascularisation

Vitreous haemorrhage

Question 15

Findings in diabetic maculopathy?

Answer 15

Macular oedema

Ischaemic maculopathy

Question 16

Complications of diabetic retinopathy?

Answer 16

Retinal detachment 
Rebeosis iridis (new blood vessel formation in the iris)
Vitreous haemorrhage 
Optic neuropathy 
Cataracts

Question 17

Management of diabetic retinopathy?

Answer 17

Laser photocoagulation
Anti-VEGF medications (ranibizumab, bevacizumab)
Vitreoretinal surgery (IF SEVERE CASE)

Question 18

Symptoms of diabetic retinopathy?

Answer 18

Visual loss due to retinal oedema
Vitreous haemorrhage Scarring
Retinal detachment
Floaters

Question 19

What type of vitreoretinal surgery occurs to help dry ARMD?

Answer 19

Vitrectomy

Question 20

Presnetation of diabetic retinopathy?

Answer 20

• Spots or dark strings floating in vision
• Blurred vision
• Fluctuating vision
• Impaired colour vision
• ark or empty areas in vision
• Vision loss

Question 21

In background retinopathy what is found?

Answer 21

Haemorrhages
Hard exudates
Aneurysms

Question 22

Pre-proliferative findings in diabetic retinopathy?

Answer 22

• Cotton wool spits
• Venous bleeding/looping
• Deep/dark cluster haemorrhages

Question 23

Proliferative findings in diabetic retinopathy?

Answer 23

• Retinal neovascularisation

- Sight threatening haemorrhages

Question 24

Side effect of laser used for treatmnet?

Answer 24

Destroys peripheral vision