Diabetic retinopathy II

Question 1

What is diabetic eye screening (DES)?

Answer 1

THE PRIMARY OBJECTIVE OF THE SCREENING PROGRAMME IS
THE DETECTION OF REFERABLE (SIGHT THREATENING)
RETINOPATHY.
THE INVITATION TO DES SCREENING IS TRIGGERED BY THE
NOTIFICATION OF DIAGNOSIS BY A PATIENT’S GP THROUGH
SCI DIABETES.

Question 2

How is DES performed?

Answer 2

FUNDUS CAMERA - SINGLE DIGITAL IMAGE, INCLUDING DISC
AUTOMATICALLY GRADED TO REMOVE PATIENTS WITH NO
RETINOPATHY.
* TRAINED, ACCREDITED GRADERS GRADE ACCORDING TO
SCOTTISH GRADING SCHEME 2007.
* THOSE WHO ARE FOUND TO HAVE POTENTIAL SIGHT
THREATENING DISEASE REFERRED INTO HES – 4% (8,422 IN
SCOTLAND) PA.

Question 3

What is referrable into HES?

Answer 3

REFERABLE – R3, R4 (PDR), M2 WITH OCT DMO (VISION
6/9 OR LESS).
* OTHER PATHOLOGY:
* CATARACT – USUALLY
* ARMD/RVO ETC…
Proliferative DR

Question 4

What is referrable maculopathy?

Answer 4

REFERRED FROM DES
* PHOTOGRAPHIC FEATURES TRIGGER OCT VISIT.
* OCT SHOWS FOVEAL DMO
* VISUAL ACUITY 6/9 OR LESS.

Question 5

Managing PDR

Answer 5

1. PANRETINAL PHOTOCOAGULATION
2. VITRECTOMY

Question 6

What is panretinal photocoagulation?

Answer 6

PANRETINAL PHOTOCOAGULATION
* GOLD STANDARD PRIMARY TREATMENT OF PDR
* REDUCES ISCHAEMIC DRIVE
* ONE-OFF TREATMENT

Question 7

What is vitrectomy?

Answer 7

VITRECTOMY:
* INDICATIONS:
* NON RESOLVING VITREOUS HAEMORRHAGE
* RECURRENT VITREOUS HAEMORRHAGE, CAUSING MORBIDITY
* 15% PATIENTS WITH ADEQUATE PRP REQUIRE VITRECTOMY.
* SURGERY IS OFTEN COMPLEX, REQUIRING DELAMINATION, SEGMENTATION,
AND RETINAL MANIPULATION IN ISCHAEMIC SICK RETINA.
* BEST DONE BEFORE BECOMING COMPLEX AND BEFORE SIGNIFICANT
VITREORETINAL TRACTION.
* VISUAL PROGNOSIS POORER IF VITREORETINAL
CONTRACTION/FIBROVASCULAR MEMBRANES.

Question 8

What are the treatments for diabetic macular oedema?

Answer 8

1. MACULAR LASER
2. ANTIVEGF
3. INTRAVITREAL STEROID IMPLANTS: OZURDEX - DEXAMETHASONE, ILUVIEN - FLUOCINOLONE

Question 9

What is macular laser?

Answer 9

USED SINCE THE MID-80S
* NON-FOVEAL TREATMENT
* REDUCES RISK OF REDUCED VISION BY 50%
* USED PREVENT FOVEAL INVOLVEMENT
* APPLIED:
* FOCALLY TO LEAKING MICROANEURYSMS
* GRID TO DIFFUSE LEAK

Question 10

What is AntiVEGF treatment?
(VASCULAR ENDOTHELIAL GROWTH FACTOR)

Answer 10

GIVEN AS INTRAVITREAL INJECTION.
* INITIALLY 5-6 INJECTIONS 4 WEEKS APART.
* RESPONSE MONITORED BY LOGMAR VISUAL ACUITY, AND
OCT.
* INCREASES VASCULAR PERMEABILITY
* INCREASED IN DIABETIC EYES, PARTICULARLY WITH
ISCHAEMIA.

Question 11

What are the types of antiVEGF given?

Answer 11

AVASTIN, LUCENTIS, EYLEA, BEOVU, FARICIMAB

Question 12

What are the disadvantages of antiVEGF?

Answer 12

1. LOCAL: ENDOPHTHALMITIS – 0.1% PER INJECTION, RETINAL DETACHMENT, LENS DAMAGE
2. SYSTEMIC: THROMBOEMBOLIC EVENTS, CVA, MI
3. FREQUENT INJECTIONS – 12/YEAR MAXIMUM

Question 13

What types of steroids for treating DMO?

Answer 13

TYPES: OZURDEX & ILUVIEN
* BLOCK VEGF (NOT TO SAME EXTENT AS ANTIVEGF).
* HAVE A BROAD AFFECT ON OTHER INFLAMMATORY MEDIATORS.
* ADVANTAGES: LESS FREQUENT DOSING
* DISADVANTAGES: CATARACT, SECONDARY OCULAR HYPERTENSION

Question 14

What are other considerations when treating DMO?

Answer 14

BETTER GLYCAEMIC CONTROL, CONTROL OF HYPERTENSION, LIPID CONTROL, TREATING ANAEMIA