Diabetic Retinopathy Picture Quiz Flashcards Preview

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Flashcards in Diabetic Retinopathy Picture Quiz Deck (31):
1

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Haemorrhages caused by leakage of blood from damaged vessels

2

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Leakage

Oedema of the retina caused by fluid leakage from damaged vessels

3

Sign? 

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Leakage

Exudates formed by lipids, lipoprotein and lipid-containing macrophages

4

Type of exudate?

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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

 

5

Sign? 

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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

 

6

What is this? 

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Background DR 
Dot blod haemorrgae

7

Sign? 

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Background DR- microaneurysm 

Tiny red dots, initially temporal to the fovea (earliest signs of DR)

 FFA: Hyperfluorescent dots

 

8

Sign? What kind of haemorrgae?

Location? Shape?

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RNFL haemorrhage
Arise from larger superficial aretrioles

Flame-like appearance

 

9

What type of harmorrhage? Location?

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Intra-retinal haemorrhageArise from venous end of capillaries

Located in the middle layers of the retina

Red, dot-blot appearance

 

10

What is it?

Cause?

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Background DR –macular oedema

Caused by extensive capillary leakage (if diffuse)
or leakage from microaneurysms & dilated capillaries (if focal)

11

Any sign? 

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No Foveal Pit

Fluid @ macula level 

Cystoid space ( fovea) 

==> Significant visual difect 

12

Sign?

Describe its appearance?

What cause it?

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Hard exudate 

Waxy yellow lesions with distinct margins

Arranged in clumps/rings

Often surround microaneurysms

When leakage stops they absorb over months or years

13

Sign present?

What disease? Specific type?

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  • Retinal thickening
  • complete or incomplete rings of hard exudates
    FOCAL MACULOPATHY

14

Signs on FFA?

What stage of FFA?

Why?

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Focal hyperfluorescence is seen on late FFA due to leakage corresponding to centre of exudate ring 
FOCAL MACULOPATHY

15

Sign present?

What disease? Type?

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Few hard exudate 

Wide-spread thickening.

Can be associated with cystoid changes.

DIFFUSE MACULOPATHY 

 

16

Sign?

What disease? Type?

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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) 

17

Sign?

What disease?

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Clinically significant macular oedema (CSMO)
Retinal macular oedema 

18

Type of Diabetes?

Sign?

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Preproliferative DR 

Retinal ischaemia 

Micro infarcts/ retinal drop out 

19

Type of DR?

Sign?

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3. PPDR – b. IRMA 

 

 

Fine, irregular red lines 

•run from the arteries to the venules 

•They are intraretinald 

•don’t cross major retinal vessels 

20

Type of DR? Sign?

Changes?

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3. PPDR – c. Other Changes i) Venous 

• Dilated & tortuous veins 

• Looping 

• Beading 

• Sausage-like segmentation 

21

Sign? Type?

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3. PPDR – c. Other Changes i) Venous 

• Dilated & tortuous veins 

• Looping 

• Beading 

• Sausage-like segmentation 

22

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3. PPDR – c. Other Changes ii) arterial changes 

• Peripheral narrowing 

• Silver-wiring 

• Obliteration 

23

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3. PPDR – c. Other Changes iii) dark blot haemorrhages 

• Haemorrhagic retinal infarcts 

• Found in the middle retinal layers 

24

Stage of DR?

Sign? Cause?

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4. 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 

25

Stage?

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4. PDR – diagnosis a. Neovascularization 

•New vessels at the disc (NVD) 

•New vessels elsewhere (NVE) 

26

Stage of DR?

What type of Neovascularisation?

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4. PDR - severity 

•MILD NVE if : 

•< . disc area in size 

•SEVERE if more than this 

27

Stage of DR?

Signs? Cause?

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4. PDR – b. fibrosis 

•Associated with 

•neovascularisation 

•If significant, can predispose 

•to tractional retinal detachment 

28

Stage of DR?

Sign? 

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5. 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) 

29

Stage of DR?

Sign? Cause?

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5. Advanced D Eye Disease Complications b.Tractional RD 

•Caused by progressive contraction of fibro-vascular membranes 

30

Stage of DR?

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5. 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 

31

Sign of what stage of DR?

Name and Cause?

Complication leading to what disease?

Commonly seen in ?

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5. 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