6 - Opth - Retinal disease - Diabetic Retinopathy Flashcards Preview

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Flashcards in 6 - Opth - Retinal disease - Diabetic Retinopathy Deck (19):
1

commonest cause of visual impairment and blindness in who?

working age population

2

What happens (simply)

occlusion +/-leakage in retinal vessels

3

RFs

DM duration
age
smoking
HTN
hyperlipidaemia
poor DM control
renal impairment
pregnancy

4

2 main types

proliferative and non-proliferative - maculopathy can occur with both

5

Non-proliferative DR - symptoms? when occurs? how classified?

-usually aSx - unless maculopathy
-after 8-10y DM
-rated as mild, moderate, severe based on ischaemia degree

6

NPDR - signs

microaneurysms (dots)
haemorrhages (dots/blots - deep in retina, flames - in nerve fibre layer)
hard exudates (yellow patches - leaked lipoproteins from diseased vasculature)
cotton wool spots - retinal nerve fibre layer infarction
vessel dilatation

7

signs of severe NPDR - (pre-proliferative)

large number of dark haemorrhages, irreg vessel dilatation 9beading) and vneous dilatation

most progess from severe NPDR to PDR within 12 months

8

Proliferative DR - more common in which DM? occurs in how many DM pts? characterised by?

T1DM
5%
formation of new vessels on optic disc and retina (neovascularisation)

9

Signs of PDR

new vessels appear initially flat but enlarge and branch irregularly into vitreous (tuffs)

10

Complications of PDR

risk of vitreous haemorrhage
rubeotic glaucoma (due to new vessel growth on iris blocking drainage)
retinal fibrosis -> tractional retinal detachment

11

Diabetic maculopathy- what significantly threatens vision? occurs in? more common in?

Macular oedema
may occur in both NPDR + PDR
more common in T2DM

12

3 types of maculopathy

focal, diffuse, ischaemic

13

Focal maculopathy?

leakage from capillaries in one part of macula -> retinal thickening and surrounding exudates (circinates)

14

Diffuse maculopathy

diffuse retinal oedema from dilated capillaries - maybe ass w haemorrhages but rarely exudates

15

Ischaemic maculopathy?

closure of foveal capillary networks -> diffuse oedema and dark haemorrhage

confirm ischaemia with fluorescein angiography

16

DR management - first principle

control DM and RF's

17

DR mgmt - laser photocoagulation for?

-PAn retinal photocoagulation in PDR
-focal/grid photocoagulation in maculopathy

18

What can you combine with photocoagulation in maculopathy? what if persistent vitreous haemorrhage?

ANTI-VEGF agents

vitrectomy

19

3 other ocular manifestations of DM

occular palsies (typically III and VI)

recurrent/non-healing corneal ulcers

cataracts

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