Management & Treatment of Diabetic Retinopathy & Complications

Question 1

Diabetic retinopathy is associated with prolonged…

Answer 1

hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension

Question 2

what Diabetic Retinopathy retinovascular changes occurs to arterioles and in which 5 ways does this happen

Answer 2

occlusion

basement membrane thickening
endothelial cell damage
RBC aggregation
increased platelet stickiness
WBC adherence

Question 3

what Diabetic Retinopathy retinovascular changes occurs to venules and how

Answer 3

leakage

loss of pericytes - the structural integrity of the BV wall

Question 4

Vision loss in diabetic retinopathy is associated with the sequelae of which of the following 2 conditions…

Answer 4

Diabetic macular oedema (DMO)
Proliferative diabetic retinopathy (PDR)

Question 5

list 4 lifestyle changes a diabetic person should make to prevent DR

Answer 5

 Glycaemic control

 Blood pressure control

 Reduce lipid in diet (lipid lowering drugs)

 Diet and exercise

Question 6

grade this image

Answer 6

R2 M1

Question 7

which type of DMO patient does the Early Treatment Diabetic Retinopathy Study (ETDRS) define as a group that would benefit from focal laser treatment

Answer 7

Clinically Significant Macular Oedema (CSMO)

Question 8

what are the 3 definitions of CSMO

Answer 8

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

Question 9

Exudates absorb gradually after…

Answer 9

Laser Tx

Question 10

Exudates worsen when…

Answer 10

systemic lipid is high (ETDRS)

Question 11

Extensive exudate within fovea causes…

Answer 11

irreversible damage

Question 12

what treatment is this a sign of

Answer 12

Temporal macular grid laser

Question 13

what treatment is this a sign of

Answer 13

Focal / grid macular laser

Question 14

Laser scars can…

Answer 14

enlarge and become confluent

Question 15

Heavy laser causes…

Answer 15

atrophy and could cause sight loss

Question 16

what does this image show and what can this cause

Answer 16

Heavy macular laser scars

which can cause scarring

Question 17

what are these local PEDs a result of and what type of complication can this cause

Answer 17

Heavy macular laser

Any breaks within Bruch’s can cause a CNV membrane as a secondary complication

Question 18

what does DMO stand for

Answer 18

diffuse macular oedema

Question 19

what treatment is safe and effective intervention for centre-involving DMO

Answer 19

Anti –VEGF

Question 20

Anti –VEGF is superior to…

Answer 20

laser alone

Question 21

Mean change in visual acuity depends on?

Answer 21

baseline mean visual acuity

Question 22

Mean change in CRT depends on?

Answer 22

baseline mean CRT

Question 23

what is the initial fixed – individualised regimen of anti VEGF injections required on average

Answer 23

average of 8-4-2 number of injections over 3 years

8 - 1st year
4 - 2nd year
2 - 3rd year

Question 24

Ranibizumab is recommended as an option for treating visual impairment due to diabetic macular oedema only if..

Answer 24

the eye has a central retinal thickness of 400μm or more at the start of treatment

Question 25

Aflibercept has been recommended as an option for treating visual impairment due to diabetic macular oedema only if..

Answer 25

the eye has a central retinal thickness of 400μm or more at the start of treatment

Question 26

would this eye qualify for intravitreal injections with anti- VEGF?

Answer 26

No because the Right CRT = 303μm

must be 400um or over

Question 27

would this eye qualify for intravitreal injections with anti- VEGF

Answer 27

Yes because Left CRT = 479μm

must be 400um or over

Question 28

what are the 3 treatment options for Proliferative DR: R3A

Answer 28

argon laser treatment (PRP) - scatter laser tx
intravitreal anti-VEGF
vitrectomy

Question 29

what did the Diabetic Retinopathy Study Randomised, prospective clinical trial evaluating PRP reveal

Answer 29

> 50% reduction in SVL (severe visual loss)

Question 30

what is shown in this image

Answer 30

PRP laser

Question 31

name 3 Adjunct treatments that Intravitreal anti-VEGF is used for

Answer 31

pre-vitrectomy
pre-cataract surgery
vitreous haemorrhage

Question 32

what DR grade is this?

Name a clinical sign shown in this image

Answer 32

Left R3AM0

new vessels at disc

Question 33

what DR grade is this?

Name 2 clinical signs shown in this image

Answer 33

Left R3A

Pre retinal fibrosis and active neovascularisation

Question 34

list 3 reasons why a Vitrectomy will need to be indicated for a person with DR

Answer 34

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

Question 35

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

Answer 35

Type 1 DM: 3 months

Type 2 DM: 4-6 months

Question 36

In treated eyes, grade does not predict…

Answer 36

visual acuity

visual outcome (acuity): depends on macular health

Question 37

visual outcome (acuity): depends on

Answer 37

macular health

Question 38

Visual acuity depends on health of macula, but macular involvement is not…

Answer 38

directly linked to DR elsewhere