Hypertensive and diabetic retinopathy

Question 1

Stages of Non-Proliferative Diabetic Retinopathy

Answer 1

Mild NPDR: At least one microaneurysm.

Moderate NPDR: More extensive microaneurysms with haemorrhages and hard exudates. May also exhibit cotton-wool spots

Severe:
Defined by the ‘4:2:1 rule’. This means there are either more than 20 intraretinal haemorrhages in each of 4 quadrants (4), definite venous beading in 2 or more quadrants (2), or prominent intraretinal microvascular abnormalities (IRMA) in 1 or more quadrant (1).

Question 2

What are cotton wool spots?

What are hard exudates?

Answer 2

Cotton wool spots - nerve fibre layer infarctions.

Hard exudates- Deposits of lipids that have leaked onto the retina through damaged vessels.

Question 3

What is proliferative diabetic retinopathy

Answer 3

Where you get neovascularisation. May present as vitreous haemorrhage or tractional retinal detachment.

Question 4

Examples of anti-VEGF

Answer 4

ranibizumab or aflibercept

Question 5

How to manage proliferative diabetic retinopathy and macular oedema

Answer 5

Laser or anti vegf

Question 6

Summary of macular degeneration

Answer 6

Struggle with night time vision
Amblers grid testing - wobbly lines
Fluctuating visual sx.

Wet or dry - dry=drusen

Wet is less common and is worse (get neovascularisation) - treated with anti VEGF
No treatment for dry