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MBChB IV Ophthalmology > Diabetic retinopathy and other retinal vascular disorders > Flashcards

Diabetic retinopathy and other retinal vascular disorders Flashcards

1
Q

Leading cause of working-age adult blindness

A

Diabetic retinopathy

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2
Q

Type 1 DM risk

A

30% >10 years

90% >30 years

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3
Q

Type 2 DM risk

A

5% at dx

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4
Q

Diabetic retinopathy pathophysiology

A

Occlusion
Microvascular disease -> BM thickening + endothelial dysfx -> haematological changes -> thrombus -> retinal hypoxia -> ischaemia -> VEGF -> neovascularisation

Leakage
Oedema

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5
Q

Majority of diabetic retinopathy symptoms caused by

A

Macular oedema

Vitreous haemorrhage

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6
Q

Signs of diabetic retinopathy

A 
Microaneurism
Exudate
Cotton wool spot
Macular oedema
Vitreous haemorrrhage
Venous beading
IRMA
Neovascularisation
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7
Q

Diabetic retinopathy classifications

A 
Background
Preproliferative
Proliferative
Maculopathy
Advanced disease
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8
Q

Background diabetic retinopathy

A

Microaneurism
Exudates
Dot blot haemorrhage

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9
Q

Preproliferative diabetic retinopathy

A

Cotton wool spots
Venous beading
IRMA

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10
Q

Proliferative diabetic retinopathy

A

NVD

NVE

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11
Q

Maculopathy

A

Cystoid macular oedema

w/wo other signs

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12
Q

Advanced diabetic retinopathy

A

Vitreous haemorrhage
Retinal detachment
NVI

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13
Q

Diabetic retinopathy screening

Ocular exam

A

VA
Dilated fundoscopy
Fundus camera
Refer if decreased VA or abnormal fundus

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14
Q

Diabetic retinopathy screening

Comorbidities

A 
HbA1c control (DMI)
BP control (DMII)
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15
Q

Diabetic retinopathy treatment

A

Control comorbidities (blood sugar, BP, cholesterol, lifestyle)
Metformin oral tx
Laser photocoagulation
AntiVEGF injection

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16
Q

Retinal vein occlusion epidemiology

A

> 50% occur in pt >65yo

Assoc with HT, dyslipidaemia, diabetic, smoking, contraceptive pill

17
Q

Retinal vein occlusion pathophysiology

A

Raised IOP
Atherosclerosis
Hypercoaguability
Virchow’s triad

18
Q

Central retinal vein occlusion

A

Occlusion at lamina cribrosa where v exits
Severe congestion (no blood exits therefore no blood enters)
Extensive oedema and haemorrhage
Blood and thunder
VA 6/60 to HM
RAPD present

19
Q

Branched retinal vein occlusion

A

Occlusion at AV crossing
Severe congestion but only portion of retinal involvement
VA 6/9 to 6/60 and loss of vision over affected retina
No RAPD

20
Q

Retinal vein occlusion treatment

A

Macular oedema - antiVEGF
Neovascularisation - antiVEGF or focal laser
Surgery for neovascular glaucoma

21
Q

Retinal artery occlusion epidemiology

A

HT
Smoker
Dyslipidaemia

Cardiac pt
Inflammatory vasculopathies
Blood dysacrasia

22
Q

Retinal artery occlusion pathophysiology

A

Embolic event
Permanent or temporary obstruction
Often carotid artery is the source

23
Q

Retinal artery occlusion temporary obstruction

A

Transient monocular vision loss

Amaurosis fugax

24
Q

Retinal artery occlusion permanent obstruction

A

Infarct in retina
Pale colour
Attenuated arteries
Permanent visual loss

25
Q

Central retinal artery occlusion

A

Emboli obstruct in lamina cribrosa region
Cherry red spot
Extensive visual loss
Profound RAPD

26
Q

Branch retinal artery occlusion

A

Sectoral vision loss

RAPD present

27
Q

Retinal artery occlusion investigations

A

BP
HBA1C
Cardiac exam, ECG, carotid auscultation
ESR, CRP (giant cell arteritis)

Special:
Carotid imaging
Cardiac imaging
Haematological testing to exclude hypercoag

28
Q

Retinal artery occlusion management

A

Treat comorbidities

Optimise patient

29
Q

Retinopathy of prematurity

A

Prem/VLBW infant
O2 used postdelivery
Hyperoxia inhibits vessel growth and then hypoxic retina releases VEGF

30
Q

Retinopathy of prematurity screening

A

<30/32 weeks
<1500g
Severe systemic illness

31
Q

Retinopathy of prematurity investigation

A

Dilated fundoscopy w indirect opthalmoscope every 1-3 weeks until zone 3 vascularised

32
Q

Retinopathy of prematurity treatment

A

Laser photocoagulation
Cryotherapy
AntiVEGF
Surgical vitrectomy

33
Q

Hypertensive retinopathy clinical signs

A 
Generalised narrowing copper/silver wiring
AV nipping focal narrowing
Flame haemorrhage
Cotton wool spots
Exudates (macular star)
Microaneurism
Papilloedema
34
Q

Hypertensive retinopathy staging

A

1 - minimal retinal artery narrowing
2 - (1) + focal narrowing and AV nipping
3 - (1) + (2) + retinal haemorrhage, hard exudate, cotton wool spots
4 - (1), (2), (3) + optic n swelling + macular star

1/2 nonmalignant
3/4 malignant

35
Q

Sickle cell retinopathy

A

Hb S+C abnormal while Hb A+B normal

Sickled RBCs not flexible enough therefore cause obstruction

36
Q

Non-proliferative sickle cell retinopathy

A

Arterial occlusion
Venous occlusion
Salmon patch retinal haemorrhage
Black sunburst scars

37
Q

Proliferative sickle cell retinopathy

A

Arterial obstruction -> AV malformation -> seafan neovascularisation -> vitreous haemorrhage -> retinal detachment

38
Q

Sickle cell retinopathy treatment

A

Screen known pt regularly
Laser photocoagulation
Surgical vitrectomy

MBChB IV Ophthalmology (17 decks)

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