FN: Diabetic retinopathy (the eye in DM) Flashcards Preview

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Flashcards in FN: Diabetic retinopathy (the eye in DM) Deck (15):
1

the problem

1. DM is leading cause of blindness up to 60yrs
2. 30% have occular problems @ presentation
3. BP

2

Pathogenesis 2 disease processess name

Cataract
Retinopathy

3

Cataract in DM

DM accelerates cataract formation
Lens absorbs glucose which is converted to sorbitol by aldose reductase

4

Retinopathy

- Microangiography - occlusion
- Occlusion leads to ischaemia and new vessel formation in retina
- Occlusion also causes cotton wool spots (ischaemia)
- Vascular leakage leads to oedema and lipid exudates
- Rupture of microaneuryms causes blot haemorrhages

5

Complications of neovascularisation

Bleed - vitreous haemorrhage
Carry fibrous tissue with them and can lead to retinal detachment

6

Screening

- All diabetcs should be screened annually
- Fundus photography
- Refer those with maculopathy, NPDR and PDR to opthalmologist - 30% NPDR develop PDR in 1yr

7

Investigation

Flourescein angiography

8

Management

- Good BP and glycaemic control
- Rx concurrent disease: HTN, dyslipidaemia, renal disease, smoking, anaemia
- Laser photocoagulation

9

Laser photocoagulation

- Maculopathy: focal or grid
- Proliferative disease: pan-retinal (macula spared)

10

CN palsies

CNIII and VI palsies may occur
In diabetic CNIII palsy the pupil may be spared as its nerve fibres run peripherally and receive blood from pial vessels

11

Fundoscopy findings 4 types

1. Background retinopathy: Leakage
2. Pre-proliferative Retinopathy: Ischaemia
3. Proliferative retinopathy
4. MAculopathy

12

Background retinopathy: Leakage

-Dots: microaneury,s
- Blots haemorrhages
- Hard exudates: yellow lipid patches

13

Pre-proliferative Retinopathy: Ischaemia

Cotton wool spots (infarcts)
Venous bleeding
Dark haemorrhages
Intra-retinal microvascular abnormalities

14

Maculopathy

Caused by macular oedema
reduced acuity may be only sign
Hard exudates w/i one disc width of macula

14

Proliferative retinopathy

New vessels
Pre-retinal or vitreous haemorrhage
Retinal detachment

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