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30 Cards in this Set
- Front
- Back
Diabetic Retinopathy: Epidemiology
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Leading cause of legal blindness age 20-70
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Diabetic Retinopathy: Prevalence
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Type 1 - 98% of >15 yrs duration
Type 2 -78% of >15 yrs duration |
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Diabetic Retinopathy: Risk Factors
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Hypertension
Renal status Puberty HbA1c Pregnancy |
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Diabetic Retinopathy: Pathophysiology
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glucose causes destructin of small blood vessels:
-capillary basement membrane thickening -pericyte loss -breakdown of blood-retinal barrier |
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Diabetic Retinopathy: Classification
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Non-proliferative Diabetic Retinopathy (NPDR)
Proliferative Diabetic Retinopathy (PDR) |
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Non-proliferative diabetic retinopathy (NPDR)
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Increased glucose causes:
-retinal vessel closer and altered vascular permeability Findings: hard exudates, dot-blot hemorrhages, NFL hemorrhages, microaneurysms, macular edema |
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Severe non-proliferative diabetic retinopathy (NPDR)
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Findings: NFL infarcts (cotton wool spots), venous dilation/bleeding/reduplication, intraretinal microvascular anomalies, extensive capillary non-perfusion
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What's the most common cause of visual loss in NPDR?
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Diabetic retinal edema (retinal thickening +/- exudate)
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Non-proliferative diabetic retinopathy treatment
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Laser cauterization of blood spots
Result is decreased macular edema/vision loss |
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Proliferative diabetic retinopathy (PDR): pathogenesis
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Retinal ischemia results in expression of VEGF
VEGF causes neovascularization of the retina elsewhere (NVE) |
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Proliferative diabetic retinopathy (PDR): symptoms
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Sudden vision loss with floaters in diabetic (caused by vitreous hemorrhage)
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Proliferative diabetic retinopathy (PDR): complications
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Vitreous hemorrhage
Tractional retinal detachment Neovascular glaucoma |
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Proliferative diabetic retinopathy (PDR): treatment
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panretinal photocoagulation (PRP) - decreases blood supply needs therefore decreasing VEGF production
Vitrectomy Surgery |
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Diabetic Retinopathy: Systemic Treatment
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Blood sugar and BP control
Maximize cardiac and renal function monitor blood lipids |
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Diabetic Retinopathy: Long term prognosis
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Excellent at 15 years
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Hypertensive Retinopahty
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HTN = SBP >140 or DBP >90
Choroid, retina and optic nerve involvement Cranial nerve palsy (decreased EOM) Ocular Strokes (visual field defects |
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Hypertensive retinopathy: pathology
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Narrowing of retinal arterioles causing physiological constriction
Chronic HTN causes sclerosis and permanent narrowing of arterioles |
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Hypertensive retinopathy: manifestations/signs
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NFL micro-infacts - cotton wool spots
Dot/blot hemorrhages (deep and perpendicular to NFL) Flame shaped hemorrhages (along NFL) |
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Ocular hypertension: Classification (Modified Scheie)
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Grade 1 - minimal arteriolar narrowing
Grade 2 - Obvious areteriolar narrowing with focal irregularities Grade 3 - Grade 2 + retinal hemorrhages and/or exudate Grade 4 - malignant hypertension - Grade 3 + swollen optic nerve |
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Malignant Hypertension
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Grade 4 Modified Scheie Classification
Swollen optic nerve, retinal arteriolar narrowing, CW spots, blot hemorrhage |
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Malignant Hypertension: Management
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Lower blood pressure gradually
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Central Retinal Vein Occulusion (CRVO): Findings
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Acute or semi-acute unilateral vision loss
venous dilation and tortuosity, intra-retinal hemorrhage everywhere, scattered CW spots, local thrombosis "Blood and Thunder" |
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Central Retinal Vein Occulusion (CRVO): Complication
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Neovascular glaucoma (painful)
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Central Retinal Vein Occulusion (CRVO): Risk Factors
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Common - diabetes, hypertension, atherosclerosis, glaucoma, old age
Rare - blood dyscarias, leukemia, polycythemia, macroglobulinemia |
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Branch Retinal Vein Occlusion (BRVO): Findings
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Some vision loss
Sectoral "blood and thunder" Complication is macular edema |
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Branch Retinal Vein Occlusion (BRVO): Risk Factor
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Hypertension is major
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Branch Retinal Vein Occlusion (BRVO): Treatment
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Laser coagulation to treat edema
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Central Retinal Artery Occlusion (CRAO): Findings
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sudden severe vision loss
afferent pupil defect, retinal pallor cherry red spot, embolus in central retinal artery |
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Central Retinal Artery Occlusion (CRAO): management
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Carotid doppler and ECG to rule out carotid occlusive disease (stroke risk)
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Amarosis Fugax
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Occular TIA (<10min usual)
Painless monocular vision loss Cause - retinal embolus, temporal arteritis |