Diabetic Retinopathy and Vascular Problems

Question 1

what causes diabetic retinopathy?

Answer 1

chronic hyperglycaemia damages retinal blood vessels and basement membrane
loss of pericytes leads to leakage of blood and ischaemia

Question 2

presentation of diabetic retinopathy on fundoscopy

Answer 2

dot and blot haemorrhage (microaneurysms)
IRMA (dilated and torturous capillaries)
hard exudates (lipids)
cotton wool spots (fat axons)
new vessels grow

Question 3

what colour is the retina?

Answer 3

transparent

Question 4

why does the retina appear pink?

Answer 4

reflection of the choroid

Question 5

what is rubeosis iridis?

Answer 5

new vessel growth

Question 6

what causes vision loss in diabetic retinopathy?

Answer 6

oedema on fovea
vitreous haemorrhage
scarring/tractional retinal detachment

Question 7

diagnosis of diabetic retinopathy

Answer 7

fundoscopy

Question 8

management of diabetic retinopathy

Answer 8

prevention with good HbA1c
laser= pan-retinal photocoagulation
anti-VEGF
vitrectomy
rehabilitation for blind/ partially sighted

Question 9

anti-VEGF examples

Answer 9

ranibizumab

bevacizumab

Question 10

what is hypertensive retinopathy?

Answer 10

damage to blood vessels due to hypertension

Question 11

when does hypertensive retinopathy develop faster?

Answer 11

malignant hypertension

Question 12

presentation of hypertensive retinopathy

Answer 12

copper/ thickened wiring of blood vessels due to thickening and sclerosis
arterioles compress veins as they harder leading to cotton wool spots ischaemia
retinal haemorrhages
disc swelling due to leakage and ischaemia

Question 13

diagnosis of hypertensive retinopathy

Answer 13

very high BP
fundoscopy
Keith-Wagener classification

Question 14

management of hypertensive retinopathy

Answer 14

control BP

Question 15

what artery supplies the inner 2/3rd of the retina?

Answer 15

central artery of the retina

Question 16

what artery supplies the peripheral 1/3rd of the retina?

Answer 16

choroid

Question 17

presentation of central retinal artery occlusion (CRAO)

Answer 17

sudden painless loss of vision
cherry red macula
RAPD
pale oedematous retina

Question 18

why does the macula stay cherry red in CRAO?

Answer 18

supplied by posterior ciliary arteries

Question 19

which condition is a type of stroke?

Answer 19

CRAO

Question 20

causes of CRAO

Answer 20

CAD
GCA
embolus from the heart

Question 21

risk factors for CRAO

Answer 21

age
FH
smoking
alcohol
hypertension

Question 22

management of CRAO

Answer 22

dislodge thrombus= massage, remove fluid, inhaling carbogen

Question 23

what is brach retinal artery occlusion (BRAO)?

Answer 23

less damage due to blockage of tributary of the central artery of the retina

Question 24

what is amaurosis fugax?

Answer 24

transient CRAO where it is momentarily blocked

Question 25

presentation of amaurosis fugax

Answer 25

painless visual loss curtain coming down <5 minutes full reocvery

Question 26

management of amaurosis fugax

Answer 26

refer to stroke clinic

Question 27

what is Virchow's triad?

Answer 27

Virchow's triad: - endothelial damage (DM) - abnormal blood flow (BP) - hypercoaguable state

Question 28

what causes central retinal vein occlusion (CRVO)?

Answer 28

artery becomes stiff and can press on top of the pliable vein causing it to be blocked Virchow's triad- venous thrombosis

Question 29

what does blockage in a vein cause?

Answer 29

back pressure causing ischaemia and forms haemorrhages and oedema

Question 30

presentation of CRVO

Answer 30

sudden painless loss of vision

Question 31

diagnosis of CRVO

Answer 31

fundoscopy FBC BP serum glucose

Question 32

appearance of CRVO on fundoscopy

Answer 32

``` haemorrhage dilated torturous vessels swelling unable to make out edges of disc cotton wool spots dark retina ```

Question 33

risk factors for CRVO

Answer 33

``` hypertension lipidaemia DM smoking SLE glaucoma ```

Question 34

management of CRVO

Answer 34

laser photocoagulation intravitreal steroids anti-VEGF

Question 35

what is branch retinal vein occlusion (BRVO)?

Answer 35

occlusion of tributary

Question 36

presentation of BRVO

Answer 36

can be asymptomatic | painless disturbance in vision/ loss of part of field

Question 37

what is ischaemic optic neuropathy?

Answer 37

occlusion of the optic nerve circulation (posterior ciliary arteries)

Question 38

presentation of ION

Answer 38

sudden painless visual loss | red flag= young patient with unilateral vision loss/ colour vision loss (MS)

Question 39

diagnosis of ION

Answer 39

examination= swollen optic nerve, edges fluffy with loss of well-define border

Question 40

what is GCA/ temporal arteritis?

Answer 40

example of an ION | posterior ciliary artery walls become inflamed and thickened until occluded

Question 41

what condition is GCA associated with?

Answer 41

polymyalgia rheumatica

Question 42

presentation of GCA

Answer 42

headache jaw claudication scalp tenderness enlarged temporal arteries (torturous appearance) patients describe not being able to brush hair, lie on affected side, etc. malaise >50

Question 43

management of GCA

Answer 43

sight-threatening | manage with steroids immediately

Question 44

what is a vitreous haemorrhage?

Answer 44

bleeding occurring from abnormal vessels

Question 45

presentation of vitreous haemorrhage

Answer 45

``` sudden visual loss floaters (fly's/spider's webs in vision) may just see red or black depending on density loss of red reflex eye red laser marks from previous ```