diabetic retinopathy Flashcards
This diabetic man complained of worsening of his vision.
What is seen on fundoscopy?
proliferative retinopathy
what is the most common cause of blindness in adults aged 35-65 years old?
diabetic retinopathy
what leads to diabetic retinopathy?
hyperglycaemia → increased retinal blood flow and abnormal metabolism in retinal vessel walls → damage to endothelial cells and pericytes
endothelial dysfunction → increased vascular permeability → exudates
pericyte formation → microaneurysms
retinal ischaemia → growth factor production → neovascularisation
how do you classify diabetic retinopathy?
- non-proliferative diabetic retinopathy (NPDR)
- proliferative diabetic retinopathy (PDR)
what are the features of mild NPDR?
1 or more microaneurysm
what are the features of moderate NPDR?
- microaneurysms
- blot haemorrhages
- hard exudates
- cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
what are the features of severe NPDR?
- blot haemorrhages and microaneurysms in 4 quadrants
- venous beading in at least 2 quadrants
- IRMA in at least 1 quadrant
what are the features of proliferative retinopathy?
- retinal neovascularisation - may lead to vitreous haemorrhage
- fibrous tissue forming anterior to retinal disc
- more common in T1DM, 50% blind in 5 years
what is 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 T2DM
This picture shows fundoscopy from a 51-year-old man.
What is the diagnosis?
treated diabetic retinopathy
(fundus shows evidence of previous laser treatment)
what do cotton wool spots represent?
areas of retinal infarction
