Hypertensive/Diabetic retinopathy Flashcards
Fundoscopy changes on diabetic retinopathy?
Blot haemorrhages
Hard exudates - yellow white deposits of lipids in the retina
Microaneurysms
Venous beading
Cotton wool spots - damage to nerves
Neovascularisation
Intraretinal microvascular abnormalities - dilated and tortuous capillaries in the retina
How can diabetic retinopathy be classified?
Proliferative and non-proliferative. Classified based on whether new blood vessels have developed.
There is also diabetic MACULOPATHY
What is considered to be mild non-proliferative diabetic retinopathy?
Microaneurysms present ONLY
weakness in walls of arteries leading to small vessel bulges
What is considered to be moderate Non-proliferative diabetic retinopathy?
Microaneurysms
Cotton wool spots
Hard exudates
Venous beading
What is considered to be severe Non-proliferative diabetic retinopathy?
Blot haemorrahges + microaneurysms in four quadrants of the eye
or
venous beading in 2 quadrants
or intraretinal microvascular abnormalities in any quadrants.
What is considered to be proliferative diabetic retinopathy
Neovascularisation (new vessels forming) and if the patient suffers with vitreous haemorrhage.
What is diabetic maculopathy?
Macular oedema and ischaemic maculopathy.
What are the complications of diabetic retinopathy?
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis - blood vessels forming on the iris
Optic neuropathy
Cataracts
How do you manage diabetic retinopathy?
Adequate control of diabetes
Laser photocoagulation
Anti-VEGF medication
Vitreoretinal surgery - required in severe disease
What is hypertensive retinopathy?
Damage to the small blood vessels in the retina as a results of chronic hypertension or quickly in response to malignant hypertension.
What are fundoscopy signs of hypertensive retinopathy?
SCROLL:
Silver wiring/copper wiring - walls of arterioles are thickened and sclerosed causing increased reflexion of light on examination
Arteriovenous nipping - arterioles cause compression of veins where veins and arteries cross
Cotton wool spots - ischaemia and infarction in the retina causing damage to nerve fibres
Hard exudates - damaged vessels leaking lipids onto retina
Retinal haemorrhages
Papilloedema
How can you classify hypertensive retinopathy?
Keith-Wagener classification
What is stage I hypertensive retinopathy?
Mild narrowing of arterioles
What is stage II hypertensive retinopathy?
Focal constriction of blood vessels and AV nipping
What is stage III hypertensive retinopathy?
Cotton wool spots
Exuates
Haemorrhages
