Retinopathy

Question 1

What is the pathophysiology of diabetic retinopathy?

Answer 1

Blood vessels in retina damaged by prolonged exposure to high blood sugar levels. Increased vascular permeability, microaneurysms, venous bleeding, nerve fibre damage, neovascularisation.

Question 2

What does damage to nerve fibres in the retina in diabetic retinopathy cause?

Answer 2

Fluffy white patches called cotton wool spots.

Question 3

What are intraretinal microvascular abnormalities (IMRA) in diabetic retinopathy?

Answer 3

Dilated and tortuous capillaries in the retina acting as shunts between arterial and venous vessels.

Question 4

What is this fundoscopy examination indicative of:

Cotton wool spots, microaneurysms, hard exudates, neovascularisation, blot haemorrhages?

Answer 4

Diabetic retinopathy (neovascularisation = proliferative)

Question 5

What are the two categories of diabetic retinopathy?

Answer 5

Non-proliferative and proliferative

Question 6

What is the progression of non-proliferative diabetic retinopathy (mild/moderate/severe)?

Answer 6

1. Mild - microaneurysms
2. Moderate - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading.
3. Severe - blot haemorrhages, microaneurysms in 4 quadrants, venous beading in 2 quadrants, intraretinal microvascular abnormality in any quadrant.

Question 7

What are the features of diabetic maculopathy?

Answer 7

Macular oedema, ischaemic maculopathy.

Question 8

What are the complications of diabetic retinopathy?

Answer 8

1. Retinal detachment
2. Vitreous haemorrhage
3. Rebeosis iridis - new vessels in iris
4. Optic neuropathy
5. Cataracts

Question 9

What is the treatment for diabetic retinopathy?

Answer 9

1. Laser photocoagulation
2. Anti-VEGF medications - ranibizumab or bevacizumab
3. Vitreoretinal surgery - severe disease, keyhole surgery

Question 10

What is the pathophysiology of hypertensive retinopathy?

Answer 10

Damage to small blood vessels in systemic hypertension due to chronic/malignant hypertension.

Question 11

What is this fundoscopy examination indicative of:

Cotton wools spots, silver wiring, hard exudates, arteriovenous nipping, papilloedema, retinal haemorrhages?

Answer 11

Hypertensive retinopathy

Question 12

What are the 4 stages of the Keith-Wagener classification of hypertensive retinopathy?

Answer 12

1. Mild narrowing of arteries
2. Focal constriction of blood vessel and AV nipping.
3. Cotton wool spots, exudates, and haemorrhage.
4. Papilloedema

Question 13

What is the management for hypertensive retinopathy?

Answer 13

Focus on controlling blood pressure and other risk factors such as smoking and blood lipid levels.