Retinopathy Flashcards
What are some risk factors for developing diabetic retinopathy?
Longer duration of Diabetes (>50% of pt with Diabetes > 10-15yr) Insulin use Higher A1C Higher systolic blood pressure Male gender Hispanic and African American
What is the leading cause of new cases of legal blindness?
diabetic retinopathy
What is pathogenesis of diabetic retinopathy
- Basement membrane thickening of retinal arterial capillaries gradually interfere with metabolic exchange and retinal nutrition
- Loss of pericytes of retinal capillaries secondary to excess glucose may weaken vascular walls leading to microaneurysm formation and fluid leakage
what is a micro aneurysm:?
capillary wall outpouching.. Bubble that keeps expanding
what is dot/blot hemorrhage?
ruptured microaneuryms in deeper layers of the retina
what are flame hemes?
rupture in more superficial layer of retina, make flame shaped hemorrage
what is retinal edema/hard exudates?
loss of blood brain barrier, leakage of proteins, serum, and lipids from vessels
what is leading cause of DR?
retinal edema
what are cotton wool spots?
nerve fiber layer infarcts secondary to occulsion of precapillary arterioles
what is the venous beading a sign of?
increasing retinal ischemia, most significant predictor of progression to PDR (proliferative diabetic retinopathy)
what is IRMA?
intraretinal microvascular abnormalities, remodeled capillary beds without proliferative changes
seen in bad diabetics
what is macular edema?
form of retinal edema specific to macular area; leading cause of visual impariment
What qualifies at mild non proliferative DR?
presence of at least 1 microaneurysm
What qualifies at moderate non proliferative DR?
presence of hemorrhages, microaneuryms, and hard exudates
What qualifies at severe non proliferative DR?
(4-2-1) hemes, microaneuryms in all 4 quadrants, with venous beading in at least 2 quadrants, and IRMA in at least 1 quadrant
what separates non-proliferative from proliferative DR?
neovascularization
what is NVD?
Any new blood vessel formation within one disc diameter of optic disc
what are pre retinal hemes?
pockets of blood in the space between the retina and posterior face of vitreous (gel that fills eye); has distinct borders
what is proliferative DR?
- Neovascularization
- Preretinal hemes
- Vitreal heme: diffuse haze
- Fibrovascular tissue
- Tractional detachment can occur (proliferation and gel pulls retina away from eye)
what is NVE?
Any new blood vessel formation outside of one disc diameter of optic disc
When can macular edema occur?
any stage of DR
what qualifications must be met to make a diagnosis of clinically significant macular edema?
- Any retinal edema within 500µm of fovea
- Hard exudates within 500 µm of fovea with retinal thickening
- Retinal edema greater than 1 disc size and within 1 disc area of fovea
what is Anti-VEGF treatment or proliferative DR and macular edema (Avastin/Lucentis)?
Injection that reduces swelling and new blood vessel growth
What is vitrectomy used for?
PDR, persistant vitreal hemes, and tractional detachments
What is vitrectomy?
suck out eye gel
when do you use anti-VEGF?
for proliferative DR and macular edema
what is laser photocoagulation/PRP used for?
CSME and PDR, NV, hemorrhage
What is laser photocoagulation/PRP?
- Body thinks eye doesn’t have enough O2… builds more blood vessels
- Kill proliferative tissue (burn tiny spots) of retina.. Reduces need for 02 supply
- Recovers damaged tissue
What are risk factors for diabetic retinopathy?
HTN and DM
What is early hypertension retinopathy?
Hypertension leads to vessel wall thickening which leads to attenuation of arterioles (arteriolosclerosis)
what is advanced stage hypertensive retinopathy?
Manifests by altering caliber and light reflex of arterioles (“copper wiring”)
what is severe hypertensive retinopathy?
Blood flow so impaired that nutritional damages occur leading to vessel shunting and A/V compression (“silver wire”). Eventually results in hemorrhaging, exudates, and edema
How is hypertensive retinopathy graded?
Grades 1 (mild) - 4 (severe)
What are management strategies for hypertensive retinopathy?
Control Blood pressure
what are treatment options for hypertensive retinopathy edema and hemes?
Laser photocoagulation, anti-VEGF injections or corticosteriod injections
What are vascular occlusions?
Blockage of retinal vasculature, central or branch, either artery or vein
what are the effects of vascular occlusions?
Results in sudden painless loss of vision, partial or complete, and can be temporary or permanent
what are the risk factors for vascular occlusions?
Hypertension Diabetes Hyperlipidemia Blood clots and certain blood disorders Blocked carotids Age (increases over age 60) Atherosclerosis Certain drugs (BCP)
what is a central retinal artery occlusion?
- Unilateral, Painless loss of vision
- Vision ranges from count fingers to Light Perception Only (LPO).
What is macular sparing?
When cilioretinal artery is present; Blood vessel that when they were born was streamed to macular vision… peripheral vision gone but central is good
What are manifestations of central retinal artery occlusion?
Manifests as a whitening of the retina, macular “cherry red” spot, APD, and retinal arteriolar narrowing
what are management strategies for CRAO and BRAO?
- no proven treatment
- poor visual prognosis
how do you test for CRAO?
ESR, CRP, FBS, CBC
what is branch retinal artery occlusion?
- Unilateral, painless, partial loss of vision
- Edema or whitening along distribution of the arterial branch
- Narrowed branch retinal arteriole or appearance of emboli (plaque or block of artery)
what are central retinal vein occlusions?
- Blockage in the main retinal vein causing stagnation of blood within the retina
- Diffuse retinal hemes in all 4 quadrants, tortuous veins, cotton wool spots, edema, and neovascularization
what is vision range for CRVO?
- Vision can range from 20/25 to LPO
- More broad range with CRVO than others
Treatment for CRVO?
- Treat underlying cause (ie Hypertension)
- PRP for ischemic areas, intravitreal Corticosteriod and/or anti-VEGF injections
What is branch retinal vein occlusion?
- Unilateral blind spot in the field of vision
- Sectoral hemorrhaging along affected venule
management of BRVO?
Management: treat underlying cause (most common HTN, DM)
work up for BRVO?
same as CRVO
Risk factors for macular degeneration?
- Genetics: abnormal
- complement factor H
- Smoking
- Age
- Cardiovascular disease/hypertension
- Obesity
- UV light exposure
management of CRAO or BRAO?
lab tests: ESR, CRP, FBS, CBC
poor prognosis
signs of CRVO?
diffuse retinal hemes in all 4 quadrants, tortuous veins, cotton wool spots, edema, NV
CRVO and BRVO management?
treat cause (HTN)
PRP for ischemic areas
intravitreal steroids
anti-VEGF injections
signs of BRVO?
unilateral blind spot
sectoral hemms
dry or wet MD more common? signs?
dry (90%)
RPE damage from waste of rods or cones
white spots
