Diabetic Retinopathy

Question 1

What is diabetic retinopathy?

Answer 1

A condition where the blood vessels are damaged due to hyperglycaemia

Question 2

What is the pathophysiology of diabetic retinopathy?

Answer 2

• Hyperglycaemia damages the retinal small vessels and endothelial cells which causes increased permeability which causes blot haemorrhages and hard exudates (lipid deposits in the retina)
• Damage also causes microaneurysms and venous beading (walls of veins are no longer straight and look like beads)
• Pre-capillary arteriolar occlusion causes retinal infarction: cotton wool spots
• Neovascularisation also takes place

Question 3

What are the 2 categories of diabetic retinopathy?

Answer 3

• Non-proliferative
• Proliferative

Question 4

How does non-proliferative present on fundoscopy?

Answer 4

Mild: Microaneurysms
Moderate: Microaneurysms, Blot haemorrhages, hard exudates, cotton wool spots and venous beading
Severe: Blot haemorrhages plus microaneurysms in 4 quadrants, venous beading in 2 quadrants

Question 5

How does proliferative diabetic retinopathy present?

Answer 5

• Retinal neovascularisation which may lead to vitreous haemorrhage
• Fibrous tissue anterior to retinal disc
• More common in T1DM

Question 6

What are complications of diabetic retinopathy?

Answer 6

• Retinal detachment
• Vitreous haemorrhage
• Optic neuropathy
• Cataracts

Question 7

How is diabetic retinopathy managed?

Answer 7

• Laser photocoagulation (suppresses new vessels)
• Anti- VGEF medications such as ranibizumab
• Vitreoretinal surgery in severe disease
• Regular opthal review and optimise DM