Diabetes and the Eye - Margalit Flashcards Preview

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Flashcards in Diabetes and the Eye - Margalit Deck (19)
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1

What is the macula?

area of the retina responsible for detailed, fine central vision - made of rods and cones

2

What is the fovea?

the center of the macula

high density of CONES, NO rods

3

Describe Microaneurysms

saccular out pouching at the site of capillary degeneration

earliest ophthalmoscopic manifestation of diabetic retinopathy

4

Describe Macular Edema

breakdown of the inner blood-retinal barrier - allowing leakage of fluid and plasma constituents into the surrounding retina

can occur in non-proliferative and proliferative diabetic retinopathy

5

Macular Edema Treatment

LASER

  • zaps leaking microaneurisms - no treatment of foveal avascular zone
  • marked absorption of fluid and lipids
  • lipids take longer to disappear by macrophages

Intraocular Steroid Injections

  • stabilizes endothelial cells and blood-retinal barrier
  • reduces immune and inflammatory response

VEGF Inhibitiors

  • inhibits vascualar endothelial growth factor - reudcing neovascualrizaation

6

Changes in NON-PROLIFERATIVE diabetic retinopathy

  • macular edema
  • changes result due to retinal ischemia and capillary obliteration
  • COTTON WOOL SPOTS
  • acute swelling of axons
  • intra-retinal microvascular abnormalities - dilation and duplication of the capillary bed
  • venous beading (irregular diameter of retinal venules)
  • capillary closure and dropout - increases Foveal Avascular Zone

7

Non-Surgical Means of Managing

Non-Proliferative Diabetic Retinopathy 

Tight glycemic control

Rx hyperlipidemia

Control hypertension

8

Disease states in which vascular changes are seen:

CVO - central retinal vein occlusion

BVO - branching retinal vein occlusion

Sickle Retinopathy

Coats' Disease

Hypertension

Sarcoidosis

Radiation Retinopathy

Hyperviscosity Syndromes

Collagen Vascular Disorders

9

Pathogeneis of Prolfierative Retinopathy

10

Nevoascularization Elsewhere

occurs with
  • severe venous beading
  • intraretinal hemorrhages
  • can occur anterior to the retina and into vitreous humor (which can apply traction to the NVE)

11

Nevoascularization of the Disc (NVD)

  • pre retinal hemorrhage (anterior to retina and into the vitreous)
  • larger fibrous component
  • can cause traction of the retina
  • can also be present with clinically signficant macular edema

12

Outcomes of Proliferative Retinopathy

traction retinal detachment

vitreous hemorrhage

neovascular glaucoma

13

Pathophysiology of traction retinal detachment and vitreous hemorrhage

  1. neovascularization anterior to the retina
  2. the posterior cortical vitreous contracts

this may induce hemorrhage - the blood will collect in the subvitreous space or vitreous cavity

14

Treatment of Proliferative Retinopathy

Viterectomy

Pantretinal Photocoagulation

VEGF Inhibitiors

15

Treatment of Proliferative Retinopathy: 

Viterectomy

indications:

  • tractional retinal detachment threatens the macula 
  • non-clearing vitreous hemorrhage

16

Treatment of Proliferative Retinopathy:

Panretinal Photocoagulation

may induce the regression of fibrovascular tissue - therefore decrease the likelihood of

  • traction detachment
  • vitreous hemorrhage
  • neurovasuclar glaucoma

17

 Epidemiology 

as the duration of diabetes increases

  • the rate of proliferative diabetic retinopathy ________
  • the occurance of macular edema ________

increases

increases

18

Glycemic Control in Diabetic Retinopathy

  • cannot completely prevent the occurance of retinopathy
  • reduction in the rate of progression
  • 35-45% reduction in risk of retinopathy progression for every 10% decrease in HbA1C

19

Other Risk factors for Diabetic Retinopathy (4)

Hypertension

Hyperlipidemia

Pregnancy

Anemia