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Clin Med I - Eye > Retinopathy > Flashcards

Retinopathy Flashcards

1
Q

What are some risk factors for developing diabetic retinopathy?

A 
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
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2
Q

What is the leading cause of new cases of legal blindness?

A

diabetic retinopathy

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3
Q

What is pathogenesis of diabetic retinopathy

A
  • 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
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4
Q

what is a micro aneurysm:?

A

capillary wall outpouching.. Bubble that keeps expanding

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5
Q

what is dot/blot hemorrhage?

A

ruptured microaneuryms in deeper layers of the retina

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6
Q

what are flame hemes?

A

rupture in more superficial layer of retina, make flame shaped hemorrage

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7
Q

what is retinal edema/hard exudates?

A

loss of blood brain barrier, leakage of proteins, serum, and lipids from vessels

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8
Q

what is leading cause of DR?

A

retinal edema

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9
Q

what are cotton wool spots?

A

nerve fiber layer infarcts secondary to occulsion of precapillary arterioles

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10
Q

what is the venous beading a sign of?

A

increasing retinal ischemia, most significant predictor of progression to PDR (proliferative diabetic retinopathy)

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11
Q

what is IRMA?

A

intraretinal microvascular abnormalities, remodeled capillary beds without proliferative changes
seen in bad diabetics

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12
Q

what is macular edema?

A

form of retinal edema specific to macular area; leading cause of visual impariment

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13
Q

What qualifies at mild non proliferative DR?

A

presence of at least 1 microaneurysm

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14
Q

What qualifies at moderate non proliferative DR?

A

presence of hemorrhages, microaneuryms, and hard exudates

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15
Q

What qualifies at severe non proliferative DR?

A

(4-2-1) hemes, microaneuryms in all 4 quadrants, with venous beading in at least 2 quadrants, and IRMA in at least 1 quadrant

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16
Q

what separates non-proliferative from proliferative DR?

A

neovascularization

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17
Q

what is NVD?

A

Any new blood vessel formation within one disc diameter of optic disc

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18
Q

what are pre retinal hemes?

A

pockets of blood in the space between the retina and posterior face of vitreous (gel that fills eye); has distinct borders

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19
Q

what is proliferative DR?

A
  • Neovascularization
  • Preretinal hemes
  • Vitreal heme: diffuse haze
  • Fibrovascular tissue
  • Tractional detachment can occur (proliferation and gel pulls retina away from eye)
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20
Q

what is NVE?

A

Any new blood vessel formation outside of one disc diameter of optic disc

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21
Q

When can macular edema occur?

A

any stage of DR

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22
Q

what qualifications must be met to make a diagnosis of clinically significant macular edema?

A
  • 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
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23
Q

what is Anti-VEGF treatment or proliferative DR and macular edema (Avastin/Lucentis)?

A

Injection that reduces swelling and new blood vessel growth

24
Q

What is vitrectomy used for?

A

PDR, persistant vitreal hemes, and tractional detachments

25
Q

What is vitrectomy?

A

suck out eye gel

26
Q

when do you use anti-VEGF?

A

for proliferative DR and macular edema

27
Q

what is laser photocoagulation/PRP used for?

A

CSME and PDR, NV, hemorrhage

28
Q

What is laser photocoagulation/PRP?

A
  • 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
29
Q

What are risk factors for diabetic retinopathy?

A

HTN and DM

30
Q

What is early hypertension retinopathy?

A

Hypertension leads to vessel wall thickening which leads to attenuation of arterioles (arteriolosclerosis)

31
Q

what is advanced stage hypertensive retinopathy?

A

Manifests by altering caliber and light reflex of arterioles (“copper wiring”)

32
Q

what is severe hypertensive retinopathy?

A

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

33
Q

How is hypertensive retinopathy graded?

A

Grades 1 (mild) - 4 (severe)

34
Q

What are management strategies for hypertensive retinopathy?

A

Control Blood pressure

35
Q

what are treatment options for hypertensive retinopathy edema and hemes?

A

Laser photocoagulation, anti-VEGF injections or corticosteriod injections

36
Q

What are vascular occlusions?

A

Blockage of retinal vasculature, central or branch, either artery or vein

37
Q

what are the effects of vascular occlusions?

A

Results in sudden painless loss of vision, partial or complete, and can be temporary or permanent

38
Q

what are the risk factors for vascular occlusions?

A 
Hypertension
Diabetes
Hyperlipidemia
Blood clots and certain blood disorders
Blocked carotids
Age (increases over age 60)
Atherosclerosis
Certain drugs (BCP)
39
Q

what is a central retinal artery occlusion?

A
  • Unilateral, Painless loss of vision

- Vision ranges from count fingers to Light Perception Only (LPO).

40
Q

What is macular sparing?

A

When cilioretinal artery is present; Blood vessel that when they were born was streamed to macular vision… peripheral vision gone but central is good

41
Q

What are manifestations of central retinal artery occlusion?

A

Manifests as a whitening of the retina, macular “cherry red” spot, APD, and retinal arteriolar narrowing

42
Q

what are management strategies for CRAO and BRAO?

A
  • no proven treatment

- poor visual prognosis

43
Q

how do you test for CRAO?

A

ESR, CRP, FBS, CBC

44
Q

what is branch retinal artery occlusion?

A
  • 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)
45
Q

what are central retinal vein occlusions?

A
  • 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
46
Q

what is vision range for CRVO?

A
  • Vision can range from 20/25 to LPO

- More broad range with CRVO than others

47
Q

Treatment for CRVO?

A
  • Treat underlying cause (ie Hypertension)

- PRP for ischemic areas, intravitreal Corticosteriod and/or anti-VEGF injections

48
Q

What is branch retinal vein occlusion?

A
  • Unilateral blind spot in the field of vision

- Sectoral hemorrhaging along affected venule

49
Q

management of BRVO?

A

Management: treat underlying cause (most common HTN, DM)

50
Q

work up for BRVO?

A

same as CRVO

51
Q

Risk factors for macular degeneration?

A
  • Genetics: abnormal
  • complement factor H
  • Smoking
  • Age
  • Cardiovascular disease/hypertension
  • Obesity
  • UV light exposure
52
Q

management of CRAO or BRAO?

A

lab tests: ESR, CRP, FBS, CBC

poor prognosis

53
Q

signs of CRVO?

A

diffuse retinal hemes in all 4 quadrants, tortuous veins, cotton wool spots, edema, NV

54
Q

CRVO and BRVO management?

A

treat cause (HTN)
PRP for ischemic areas
intravitreal steroids
anti-VEGF injections

55
Q

signs of BRVO?

A

unilateral blind spot

sectoral hemms

56
Q

dry or wet MD more common? signs?

A

dry (90%)
RPE damage from waste of rods or cones
white spots

Clin Med I - Eye (5 decks)

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