Diabtes 2 Flashcards
how would u treat diabetic retinopathy
often asymptomatic- screening essential
medical reatment
eye treatment- surgery, laser photocoagulation, intravitreal injections
why would u manage medical side
to delay onset and prevent progression to complications
microangiopathic probs- kidney/eye disease
macroangiopathic probs- heart/ brain disease
what are the targets for diabetes control
HbA1c , 7.0%- target (Blood test to measure glyocolated
haemoglobin in red blood cells)
BP ,140/80-
Cholesterol <4mmol/l
what do u do for different types of maculopathy
focal maculopathy- focal laser
if its diffuse- grid laser
and if ischeamic- no laser- capillaries are blocked so how would that help
for proliferative retinopathy- panretinal photocoagulation- for peripheral retina
tell me bout laser photocoagulation beauts
outpatient
local anaestasia with contact lens and contact gel- laser from slit lamp
focal/panretinal photocoagulation
for macular- yellow/green laser
for pan retinal- melanin absorbed best by all colours- u could use any colour
why does pan retinal photocoagualtion work
treats peripheral retina kills retina ischematic stops vascular endothelium growth factors normally 3 sessions- of 3000 burns
focal layer
treat directly the leaking spots
to stop exudates spreading to fovea -
laser looks fluffy and white after a few months then scars
what are the issues with laser
about 60% most effective
destructive
some discomfort with photo- coat therefore in a few sessions
accidental foveal burn- when px oohs at laser directly- immediate permanent loss of vision
ischemic maculopahty may deotoriate
with peripheral laser- reduced VF, cotoma, decreased night vision, choroidal detachment, pre-retinal heammorahge
advacned diabetic disease- scar- new blood vessels growing. wot would u do
laser may not be as helpful
may need surgery first to remove scar
whats vicrectomy
under anaesthetic
takes 2hours
3 entry points- pars plana- no retina here
1 port for infusion
2nd for light
3rd to cut and suck scar tissue and a haemorrhage
how would u image and assess dr
fundus photography
oct
fl angiography
anti VEGf
with DR-vascular endothelium growth factors increased- so we reduce- so targets pathogenesis of DMO
intravitreal injections for DR- given in clean room with local aneasthesia- out px- dafe
risks of endopthalmitis, heammoraghe, cataract, systemic side effects
Triamcinolone- dexamethasone- steroid- injected into joint- lessening DMO- last for a long time- but side effect glaucoma and cataract- not used anymore
Avastin- bevacisumab- not for eyes for cancer- cheaper- larger molecule- enters body from eye- increased risk of hurt attack and stroke
Lucentis- rhamibizumab- effective more than laser- safe- EXPENSIVE- monthly monitoring needed- lots of injections for unknown amount of time
Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone Triamcinolone
dexamethasone
Avastin
Bevacizumab
Lucentis
Ranibizumab
How do we know lucentis works
diabetic retinopathy clinical research network and
national eye institution
whether laser and injection or laser alone for DMO
Sight preserving- doesn’t improve sight
how would u treat DR with macular odeama
laser initially- cheap- if don’t work or CRT is expensive- then anti vegF
avastin/ triamcinolone/lucentis
anti VEGF’s in prolifertaive retinopathy
prevents new blood vessel growth
used in px with vitreous heammorahge before vitrectomy- less bleeding
BUT can cause rapid contraction of retinal fibrous tissue- RD?
effective for use in neivascular glaucoma- aka rubeodsis iridis
what is the grading fro DR
R0- nothing- annual review
R1- Background retinopathy- annual review
R2-pre-proliferative-routine referral
R3-proliferative- URGENT referral
