Diabetic Retinopathy COPY

Question 1

What are the risk factors for diabetic retinopathy?

Answer 1

• Hypertension
• Ethnicity
• Obesity
• Diet
• Diabetes duration
• Smoking

Question 2

What are the two classification of diabetic retinopathy?

Answer 2

• Non-Proliferative DR

- Proliferative DR

Question 3

What is the pathogenesis of Non-Proliferative DR?

Answer 3

• For NPDR:
• Extended hyperglycaemia causes damage to the vascular endothelial (loss of pericytes + basement membrane thickening)
• Leukocytes adhere to capillary wall causing capillary occlusion.

Question 4

What is the pathogenesis of Proliferative Diabetic Retinopathy?

Answer 4

• Extended ischaemia releases VEGF promoting new blood vessels which are weak and bleed leading to hamorrhages (cotton wool spots, neovascularisation, venous beading)

Question 5

What is the pathogenesis of diabetic macular oedema?

Answer 5

• Chronic inflammation + endothelial damage causes increased vascular permeability -> more microaneurysms and exudates

Question 6

What are the signs with their releveant grading of NPDR and PDR?

Answer 6

R1: Microaneurysms, retinal haemorrhages. hard exudates, cotton wool spot, venous looping.
R2: All above + venous beading, IRMA, blot haemorrhages
R3A: All above + NVD, NVE, vitreous haemorrhages, traction retinal detachment
R3S: All above + laser scars, stable old ‘new’ vessels

Question 7

What is the referral for diabetic retinopathy?

Answer 7

R1: Monitor every 6 months
R2: Urgent referral with screning scheme
R3A; Emergency Referral with screening scheme
R3S: Monitor every 6 months

Question 8

What are the investigations for px with diabetic retinopathy?

Answer 8

• FFA
• OCT
• H&S
• Slit lamp

Question 9

What are the treatments for diabetic retinopathy?

Answer 9

R1: Lifestyle Advice
R2: Monitor every 6 months, assess diabetic control. lifestyle advice, FFA
R3A: Laser PRP and could do vitrectomy
DMO: Anti-VEGF (ranibuzimab + afilbercept) or corticosteroids (dexamethasone implant)

Question 10

What is the differential diagnosis of DR?

Answer 10

• Hypertensive Retinopathy

Question 11

What are the features of M0 and M1 maculopathy?

Answer 11

M0
MA/ haemorrhage within 1DD of fovea
BCVA better than 6/12

M1:
1)exude within 1dd of Centre of fovea
2)group of exudes that equate to >1/2DD
3)retinal thickening within 1DD of Central of fovea
4) any MA/haemorrhage within 1dd
BCVA 6/12 or worse