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RETINOPATHY
ANATOMY OF THE EYE
1. The retina : senses light & transmits images to the brain
2. The macula : central part of the retina used to read and see fine details clearly
3. The vitreous : clear gel fills the back of the eye and sits in front of the retina
RETINAL ANATOMY
DIABETIC RETINOPATHY
Occurs when elevated blood sugar levels cause blood vessels in the eye to swell and leak into the retina.
Diabetic macula edema (swelling of the retina)
SIGN AND SYMPTOMP
1. Blurred vision2. Floaters3. Fluctuating vision4. Distorted vision 5. Dark areas in the vision6. Poor night vision7. Impaired color vision8. Partial or total loss of vision
Normal Vision
How vision may be affected by diabetic retinopathy
RISK FACTOR
Duration and severity of diabetic is a major risk factor associated with the development of retinopathy diabetic
PATHOPHYSIOLOGY
Diabetic Retinopathy is a microvasculopathy that causes:1. Retinal capillary occlusion, is caused by thickening of
capillary basement membranes, increased platelet adhesion, Increased blood viscosity
2. Retinal capillary leakage, is caused by Impairment of endothelial tight junctions, Weakening of capillary walls, elevated levels of vascular endothelial growth factor (VEGF)
TYPES OF DIABETIC RETINOPATHY
Early stage1. Non-proliferative diabetic retinopathy (NPDR)
Damaged blood vessels in the retina begin to leak fluid and small amounts of blood and cholesterol.
TYPES OF DIABETIC RETINOPATHY
Lata stage
2. Proliferative diabetic retinopathy (PDR) The retina responds by growing new abnormal vessels.3. Vitreous hemorrhage
New blood vessels bleed into vitreous cavity.4. Tractional retinal detachment
Scar tissue can shrink causing the retina to detach and result in vision loss. More severe vision loss occurs if the macula is detached.
Tractional retinal detachment
STAGE OF NPDR
1. Mild Microaneurysms only
Microaneurysms
STAGE OF DIABETIC RETINOPATHY NPDR
2. Moderate More than just microaneurysms but less than severe NPDR
Hard exudates
microaneurysm
STAGE OF DIABETIC RETINOPATHY NPDR
3. SevereDefinite venous beading in two or more quadrants Venous beading
CHARATERISTICS OF PDR
1. Neovascularization 2. Vitreous/preretinal hemorrhage
Neovascularization
NeovascularizationHard exudate
Cotton-wool spot
Blot hemorrhage
Hard exudate Cotton wool spot
DIAGNOSTIC TEST
Bassic assesment1. Visual acuity test2. Tonometry: Measures pressure inside
the eye3. Dilated eye exam
Advanced assesment4. Fluorescein angiogram: dye is
injected systemically which demonstrates retinal circulation
5. Optical coherence tomography (OCT): non-invasive imaging study that reveals retinal anatomy
Fluorescein angiogram
Optical coherencetomography (OCT)
TREATMENT
Proliferative diabetic retinopathy1. Laser surgerya. Microscopic thermal laser burns are made in the retinab. Shrinks and prevents abnormal new blood vessel
growth, and stops leaking of blood vessels Can reduce risk of further vision loss by 50%
c. Also recommended to treat macular edema
2. Intraocular (anti-VEGF) injectionsa. Reduces swelling in the retina and
causes abnormal vessels to regress
Intraocular injection
TREATMENT
TREATMENT
c. Vitrectomyd. Cloudy vitreous is removed and replaced with a clear
solution hat mimics the normal eye fluids e. Allows light rays to focus on the retina again
HYPERTENSION RETINOPATHY
Hypertensive retinopathy is retinal vascular damage caused by hypertension.
PATHOPHYSIOLOGY
Systermic chronic
hypertension
atherosclerosis
Narrowing of retinal
arterioles
Retinal Ischaemia Hypoxia
Increased capillary
permeability
Focal Retinal Oedema, retinal haemorrhage,cotton wool spots,
hard exudates
CLINICAL MANIFESTATION
1. Most patients are asymptomatic. 2. Some present with headaches and blurred
vision.3. On ophthalmoscopy :
a. Generalized arteriolar narrowingb. Flame haemorrhagec. Microaneurysmsd. Exudatese. Arteriolar macroaneurysmsf. Cotton-wool spotsg. Optic disc swelling
CLASSIFICATION
DIAGNOSIS1. Diagnosis is made by
thorough history of the patient, ophthalmoscopy (direct or indirect) and also physical examination.
2. History a. May reveal decrease of
patient vision, occipital headache and high blood pressure.
3. Physical examinationa. May detect elevation of
blood pressure
4. Ophthalmoscopy
a. Cotton-wool spotb. Flame haemorrhagec. Silver wire appearance of
narrowed arteriolesd. Nicking of veins where
arteries cross them (arteriovenous nicking)
e. Hard exudates “lipids deposites”
f. “Macular star”g. Flame shape haemorrhageh. Retinal oedemai. Swelling of the optic nervej. Aterial microaneurysmsk. Arteriolar macroaneurysms
MANAGEMENT
1. A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure.
2. Lifestyle changes Promote Healthy lifestyle; exercise, healthy foods
3. Advice patient to reduce the Blood Pressure a. Taking the medication accordinglyb. Referral to medical team