Lab 2 - Retinal Vacular Changes

Question 1

Describe what you would observe upon fundoscopy of a patient with non-proliferative diabetic retinopathy

Answer 1

• microaneurysms
• dot/blot haemorrhages
• exudates
• venous beading/loops
• IRMAs - abnormal branching/dilation of existing capillaries
• cotton wool spots

Question 2

Describe what you would observe upon fundoscopy of a patient with proliferative diabetic retinopathy

Answer 2

• microaneurysms
• dot/blot haemorrhages
• exudates
• venous beading/loops
• IRMAs - abnormal branching/dilation of existing capillaries
• cotton wool spots

AND

• neovascularisation in response to retinal ischaemia
• preretinal/subhyaloid/vitreous haemorrhages
• scarrring & detachment
• CSMO - macular oedema specifically related to DR

Question 3

Describe what you would observe upon fundoscopy of a patient with hypertensive retinopathy

Answer 3

• Retinal arterial narrowing, A/V ratio <1/2 (usually 2/3 or 3/4)
• A/V nicking, venous beading
• mainly flame haemorrhages
• cotton wool spots
• hard exudates
• ONH swelling (if severe)
• retinal/macular oedema
• increased vascular toruosity
• copper/silver wiring

Question 4

Describe what you would observe upon fundoscopy of a patient with hypertensive choroidopathy

Answer 4

Elschnig spots - hyperpigmented spots surrounded by hypopigmented ring on choroid

Siegrist streaks - linear hyperpigmented lesions over choroidal arteries

Question 5

Describe what you would observe upon fundoscopy of a patient with hypertensive optic neuropathy

Answer 5

Blurred ONH margins with haemorrhages, congested retinal veins, macular exudates, florid ONH oedema

Question 6

Describe what you would observe upon fundoscopy of a patient with BRAO

Answer 6

Whitening of superficial retina in one area, narrowing of arterioles/venules, tissue ischaemia/oedema, box-carring/cattle-trucking of vessels

Potentially would observe hollenhorst’s plaques

Question 7

Describe what you would observe upon fundoscopy of a patient with CRAO

Answer 7

Yellow-white opaque retina, cherry red spot

Question 8

Describe what you would observe upon fundoscopy of a patient with CRAO with cilioretinal sparing

Answer 8

Retinal pallor with normal looking retina between ONH and fovea - may allow retention of central vision

Question 9

Describe what you would observe upon fundoscopy of a patient with BRVO

Answer 9

• Intraretinal haemorrhages (generally flame) adjacent to dilated, tortuous vein
• retinal oedema
• cotton wool spots

Question 10

Describe what you would observe upon fundoscopy of a patient with CRVO

Answer 10

• retinal haemorrhages
• dilated tortuous retinal veins
• cotton wool spots
• macular oedema
• ONH oedema

Question 11

Describe the difference between ischaemic and non-ischaemic CRVO

Answer 11

Non-ischaemic:

• relatively good VA
• no RAPD
• few retinal haemorrhages and cotton wool spots
• good retinal perfusion
• may resolve fully with good VA

Ischaemic:

• severe vision loss
• RAPD
• extensive retinal haemorrhaging and cotton wool spots
• poor retinal perfusion
• poor prognosis
• can lead to rubeosis iridis (—-> neovascular glaucoma)

Question 12

Describe the pathophysiology of diabetic retinopathy

Answer 12

Multifactorial

• elevated levels of glucose leads to accumulation of sorbitol, causing pericyte loss and vessel leakiness
• thickening of basement membrane and higher coagulants in blood restrict blood flow into smaller capillaries
• poor blood circulation and decreased oxygen delivery to downstream tissues

Question 13

Describe the pathophysiology of hypertensive retinopathy

Answer 13

Sustained systemic hypertension causes thickening of vessel walls and narrwowing of the lumen. This causes mechanical changes in the retinal and choroidal vasculature.