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APP4 > Retinopathy > Flashcards

Retinopathy Flashcards

1
Q

What is retinopathy?

A

disease of the retina that causes impairment or loss of vision

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2
Q

what are the types of retinopathy?

A

diabetes
hypertension
radiation
retinal vascular disease
trauma

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3
Q

what are the most common affect of diabetic retinopathy?

A
  • affecting the small vessels (microangiopathy)
    • precapillary arterioles
    • capillaries
    • postcapillary venules
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4
Q

what vessels are affected in diabetic retinopathy?

A
  • precapillary arterioles
    • capillaries
    • postcapillary venules
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5
Q

what is the pathology of microangiopathy (affecting the small vessels)?

A
  1. thickening/multilayering of basement membranes
  2. degeneration of endothelial cells and pericytes
  3. subsequent capillary non-perfusion and tissue ischemia
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6
Q

what are the clinical features of diabetic retinopathy?

A
  1. Microaneurysms - Weakening of vessel wall causing bulging of walls
  2. Haemorrhage
    • Damage to vessel walls => (bleed into layers of retina)
    • Dot haemorrhage – rupture of capillaries in outer plexiform layer
    • Blot haemorrhage – larger than dot haemorrhages, bleeding from
      capillaries – tracks between photoreceptors + RPE
    • Flame haemorrhages – rupture of small arteriole => leakage into nerve
      fibre layer
  3. Hard exudates
    • Endothelial damage => plasma leakage into outer plexiform layer – “”
  4. Cotton wool spots
    • Swollen ends of interrupted axons in nerve fibre layer due to micro-
      infarction
  5. Venous beading
    • Beaded appearance to veins, reflects retinal ischaemia
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7
Q

what are the features of advanced diabetic retinopathy?

A
  1. Intraretinal microvascular abnormalities (IRMA)
    • Vascular abnormalities in venous side of capillary bed (do not leak) causing a precursors of neovascularisation
  2. Neovascularisation
    • New vessels grow from venous side of capillary bed in area of non-perfusion (new vessels leak)
    • Due to vasoproliferative factors released by ischaemic retina => proliferation of endothelial cells at edge of ischaemic area
    • New vessels grow near disc “NVE”, elsewhere in retina “NVE”, in the anterior chamber angle “NVA” and in the iris “NVI”/rubosis iridis
    • Vessels can bleed into vitreous, cause retinal detachment, and glaucoma
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8
Q

when are diabetic retinopathy reviews undergone? and when?

A

annually

for diabetic patients

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9
Q

what do diabetic retinopathy reviews assess?

A

photographs of the retina then classified into severity levels

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10
Q

describe diabetic maculopathy?

A

leaking of macula, often with exudates, often surrounding a microaneurysms known as DIABETIC MACULAR OEDEMA

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11
Q

What is diabetic macular oedema?

A

leaking of macula often surrounding a micro aneurysm

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12
Q

what can be seen from a diabetic retinopathy review?

A
  1. cotton wool spots
  2. microaneurysms, oedema and exudates
  3. neovascularisation
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13
Q

what can be seen from proliferative diabetic retinopathy in a retinal scan?

A

abnormal vessels - haemorrage in the retina

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14
Q

how is diabetic retinopathy managed?

A

systemic control
- glycaemic control
- BP control
- cholesterol control
- support renal function
- smoking cessation
- weight control
- exercice

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15
Q

how are diabetic retinopathy monitored?

A
  1. yearly screening for mild NPDR
  2. hospital service screening for pre-proliferative/moderate-severe NPDR
  3. laser for proliferative
  4. macular laser for maculopathy
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16
Q

what is panretinal photocoagulation (PRP)?

A

green laser absorbed by the RPE pigment

laser is converted into thermal energy causing outer retinal cell death and coagulative necrosis
= reducing neovascularisation stimulus - VEGF

17
Q

what are the risks of PRP?

A
  1. pain
  2. loss of peripheral field e.g. when driving
  3. accidental foveal burns = decreased viewing
  4. retinal detachment
  5. haemorrhage
18
Q

what is macular laser?

A

similar to PRP

used for gentle burns to macula and treat macular oedema

19
Q

what is intravitreal anti-VEGF?

A

for diabetic macular oedema

20
Q

name licensed intravitreal anti-VEGF?

A

aflibercept
ranibizumab

21
Q

what is aflibercept prescribing based upon?

A

central retinal thickness >400micrometres

22
Q

how is central retinal thickness determined?

A

optical coherence topography

23
Q

describe optical coherence topography

A

uses infrared light to capture an image of layers of retina to measure central retinal thickness

24
Q

what is ranibizumab prescribing based upon?

A

visual impairments due to diabetic macular oedema
with a central retinal thickness >400 micrometres

25
Q

what is the mechanism of action of intravitreal corticosteroid?

A

suppress inflammation causing a reduce in oedema
with anti-VEGF properties

26
Q

name the risks of intravitreal corticosteroid?

A
  1. infection
  2. haemorrhage
  3. retinal detachment
  4. increasing intraocular pressure
  5. cataract
27
Q

name an examples of intravitreal corticosteroids?

A
  1. dexamethasone intravitreal
28
Q

what is retinal vein occlusion?

A

blockage of the venules

29
Q

describe the treatment of retinal vein occlusion

A
  1. treat underlying hypertension conditions
  2. PRP
  3. control IOP
  4. intravitreal therapy
    • corticosteroid
    • anti-VEGF
30
Q

describe clinical features seen of retinal vein occlusion

A
  1. ischemia of the retina /widespread ischemia
  2. multiple haemorrhages
  3. oedema
  4. wool spots
31
Q

describe the treatment of retinal artery occlusion

A
  1. treat underlying hypertension conditions
  2. treat underlying vasculitis/arteritis
  3. lower IOP

APP4 (14 decks)

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