Management & Treatment of Diabetic Retinopathy & Complications Flashcards
Diabetic retinopathy is associated with prolonged…
hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension
what Diabetic Retinopathy retinovascular changes occurs to arterioles and in which 5 ways does this happen
occlusion
basement membrane thickening
endothelial cell damage
RBC aggregation
increased platelet stickiness
WBC adherence
what Diabetic Retinopathy retinovascular changes occurs to venules and how
leakage
loss of pericytes - the structural integrity of the BV wall
Vision loss in diabetic retinopathy is associated with the sequelae of which of the following 2 conditions…
Diabetic macular oedema (DMO)
Proliferative diabetic retinopathy (PDR)
list 4 lifestyle changes a diabetic person should make to prevent DR
Glycaemic control
Blood pressure control
Reduce lipid in diet (lipid lowering drugs)
Diet and exercise
grade this image
R2 M1
which type of DMO patient does the Early Treatment Diabetic Retinopathy Study (ETDRS) define as a group that would benefit from focal laser treatment
Clinically Significant Macular Oedema (CSMO)
what are the 3 definitions of CSMO
Retinal oedema/thickening located at or within 500ųm of the centre of the macula
Exudates at or within 500ųm of the centre of the macula if associated with thickening (oedema) of the adjacent retina
A zone of thickening (oedema) larger than 1 disc area if located within 1 disc diameter of the centre of the macula
Exudates absorb gradually after…
Laser Tx
Exudates worsen when…
systemic lipid is high (ETDRS)
Extensive exudate within fovea causes…
irreversible damage
what treatment is this a sign of
Temporal macular grid laser
what treatment is this a sign of
Focal / grid macular laser
Laser scars can…
enlarge and become confluent
Heavy laser causes…
atrophy and could cause sight loss
what does this image show and what can this cause
Heavy macular laser scars
which can cause scarring
what are these local PEDs a result of and what type of complication can this cause
Heavy macular laser
Any breaks within Bruch’s can cause a CNV membrane as a secondary complication
what does DMO stand for
diffuse macular oedema
what treatment is safe and effective intervention for centre-involving DMO
Anti –VEGF
Anti –VEGF is superior to…
laser alone
Mean change in visual acuity depends on?
baseline mean visual acuity
Mean change in CRT depends on?
baseline mean CRT
what is the initial fixed – individualised regimen of anti VEGF injections required on average
average of 8-4-2 number of injections over 3 years
8 - 1st year
4 - 2nd year
2 - 3rd year
Ranibizumab is recommended as an option for treating visual impairment due to diabetic macular oedema only if..
the eye has a central retinal thickness of 400μm or more at the start of treatment
Aflibercept has been recommended as an option for treating visual impairment due to diabetic macular oedema only if..
the eye has a central retinal thickness of 400μm or more at the start of treatment
would this eye qualify for intravitreal injections with anti- VEGF?
No because the Right CRT = 303μm
must be 400um or over
would this eye qualify for intravitreal injections with anti- VEGF
Yes because Left CRT = 479μm
must be 400um or over
what are the 3 treatment options for Proliferative DR: R3A
argon laser treatment (PRP) - scatter laser tx
intravitreal anti-VEGF
vitrectomy
what did the Diabetic Retinopathy Study Randomised, prospective clinical trial evaluating PRP reveal
> 50% reduction in SVL (severe visual loss)
what is shown in this image
PRP laser
name 3 Adjunct treatments that Intravitreal anti-VEGF is used for
pre-vitrectomy
pre-cataract surgery
vitreous haemorrhage
what DR grade is this?
Name a clinical sign shown in this image
Left R3AM0
new vessels at disc
what DR grade is this?
Name 2 clinical signs shown in this image
Left R3A
Pre retinal fibrosis and active neovascularisation
list 3 reasons why a Vitrectomy will need to be indicated for a person with DR
Non-clearing / recurrent vitreous haemorrhage
- Type 1 DM: 3 months
- Type 2 DM: 4-6 months
Tractional retinal detachment threatening macula
Combined tractional & rhegmatogeous retinal detachment
within what time scale should a Vitrectomy be carried out for a DR px with Non-clearing / recurrent vitreous haemorrhage who has T1 and T2 diabetes respectively
Type 1 DM: 3 months
Type 2 DM: 4-6 months
In treated eyes, grade does not predict…
visual acuity
visual outcome (acuity): depends on macular health
visual outcome (acuity): depends on
macular health
Visual acuity depends on health of macula, but macular involvement is not…
directly linked to DR elsewhere
