Diabetic Retinopathy Picture Quiz Flashcards
Haemorrhages caused by leakage of blood from damaged vessels
Leakage
Oedema of the retina caused by fluid leakage from damaged vessels
Sign?
Leakage
Exudates formed by lipids, lipoprotein and lipid-containing macrophages
Type of exudate?
Cotton wool spots
Used to be called “soft exudates”
Fluffy, white focal lesions with indistinct margins
Occur at the margins of an ischaemic retinal infarct
Caused by obstruction of axoplasmic flow & build up of axonal debris in the nerve fibre layer of the retina
Sign?
Neovascularisation (new vessels)Vasogenic factors (VEGF) are released in an ischaemic retina
Causes growth of abnormal vessels & fibrous tissue on to the retinal surface & forwards into the vitreous
The intravitreal vessels are more permeable than normal retinal vessels & b/c they are located in an abnormal position they break and bleed
What is this?
Background DR
Dot blod haemorrgae
Sign?
Background DR- microaneurysm
Tiny red dots, initially temporal to the fovea (earliest signs of DR)
FFA: Hyperfluorescent dots
Sign? What kind of haemorrgae?
Location? Shape?
RNFL haemorrhage
Arise from larger superficial aretrioles
Flame-like appearance
What type of harmorrhage? Location?
Intra-retinal haemorrhageArise from venous end of capillaries
Located in the middle layers of the retina
Red, dot-blot appearance
What is it?
Cause?
Background DR –macular oedema
Caused by extensive capillary leakage (if diffuse)
or leakage from microaneurysms & dilated capillaries (if focal)
Any sign?
No Foveal Pit
Fluid @ macula level
Cystoid space ( fovea)
==> Significant visual difect
Sign?
Describe its appearance?
What cause it?
Hard exudate
Waxy yellow lesions with distinct margins
Arranged in clumps/rings
Often surround microaneurysms
When leakage stops they absorb over months or years
Sign present?
What disease? Specific type?
- Retinal thickening
- complete or incomplete rings of hard exudates
FOCAL MACULOPATHY
Signs on FFA?
What stage of FFA?
Why?
Focal hyperfluorescence is seen on late FFA due to leakage corresponding to centre of exudate ring
FOCAL MACULOPATHY
Sign present?
What disease? Type?
Few hard exudate
Wide-spread thickening.
Can be associated with cystoid changes.
DIFFUSE MACULOPATHY
Sign?
What disease? Type?
Ischaemic maculopathy
Variable signs.
Macular can look normal.
Prolifrerative DR can also be present
FFA: show HYPOFLUERESCEIN ( due to capillary non-perfusion at macula and elsewhere)
Sign?
What disease?
Clinically significant macular oedema (CSMO)
Retinal macular oedema
Type of Diabetes?
Sign?
Preproliferative DR
Retinal ischaemia
Micro infarcts/ retinal drop out
Type of DR?
Sign?
- PPDR – b. IRMA
Fine, irregular red lines
- run from the arteries to the venules
- They are intraretinald
- don’t cross major retinal vessels
Type of DR? Sign?
Changes?
- PPDR – c. Other Changes i) Venous
- Dilated & tortuous veins
- Looping
- Beading
- Sausage-like segmentation
Sign? Type?
- PPDR – c. Other Changes i) Venous
- Dilated & tortuous veins
- Looping
- Beading
- Sausage-like segmentation
- PPDR – c. Other Changes ii) arterial changes
• Peripheral narrowing
• Silver-wiring
• Obliteration
- PPDR – c. Other Changes iii) dark blot haemorrhages
- Haemorrhagic retinal infarcts
- Found in the middle retinal layers
Stage of DR?
Sign? Cause?
- PDR – pathogenesis a. Neovascularization
- Primary feature is neovascularisation
- Caused by
- angiogenic growth factors
- increased by hypoxic retinal tissue in an attempt to re-vascularise the hypoxic retina
- Angiogenic substances encourage neovascularisation in the retina, ON head & sometimes iris
Stage?
- PDR – diagnosis a. Neovascularization
- New vessels at the disc (NVD)
- New vessels elsewhere (NVE)
Stage of DR?
What type of Neovascularisation?
- PDR - severity
- MILD NVE if :
- < . disc area in size
- SEVERE if more than this
Stage of DR?
Signs? Cause?
- PDR – b. fibrosis
- Associated with
- neovascularisation
- If significant, can predispose
- to tractional retinal detachment
Stage of DR?
Sign?
- Advanced D Eye Disease Complications a.haemorrhage
Can be pre-retinal or intragel
Pre-retinal often has a crescent shape & intragel haemorrhages take longer to clear
(b/c they result from a more extensive bleed)
Stage of DR?
Sign? Cause?
- Advanced D Eye Disease Complications b.Tractional RD
•Caused by progressive contraction of fibro-vascular membranes
Stage of DR?
- Advanced D Eye Disease Complications c.Retinoschisis
- Can occur with/without RD
- The difference is difficult to determine clinically
- Sometimes OCT can help with diagnosis
TR TRD
Sign of what stage of DR?
Name and Cause?
Complication leading to what disease?
Commonly seen in ?
- Advanced D Eye Disease Complications d.Rubeosis Irides
- Can cause glaucoma if severe
- Common in eyes with severe retinal ischaemia or persistent retinal detachment following treatment
