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
