Diabetic retinopathy

201 Diabetic retinopathy




Instruction


Examine the fundus in these patients.



• You will be expected to comment on whether it is background (Fig. 201.1) or proliferative (Fig. 201.2) retinopathy.


• You may have a clue about the underlying diabetes, either from a diabetic chart or from the presence of diabetic fruit juices at the bedside.


image

Fig. 201.1 Background retinopathy.


image

Fig. 201.2 Proliferative retinopathy.



Patient 1



Salient features



History




• Gradual or acute loss of vision


• History of floaters


• History of diabetes, hypertension


• Ask about renal disease (renal-retinal syndrome of diabetes).



Examination




• Background retinopathy, caused by microvascular leakage into the retina:


• Microaneurysms, usually seen in the posterior pole temporal to the fovea

• Dot and blot haemorrhages (Fig. 201.3B)

• Hard exudates (Fig. 201.3C)

• Cottonwool spots (Fig. 201.3D).

image image

Fig. 201.3 Diabetic eye disease. (A) Normal macula and optic disc. (B) Early background retinopathy, dot and blot haemorrhages. (C) Early background retinopathy, plus hard exudates. (D) Preproliferative retinopathy, with multiple cotton-wool spots. (E) Proliferative retinopathy, with hallmark frond-like new vesicles. (F) Exudative maculopathy, with exudates within a disc-width of the macula.(G,H) Central (G) and cortical (H) cataracts seen against the red reflex of the ophthalmoscope.


(With permission from Kumar, Clark 2005.)



Diagnosis


This patient has dot and blot haemorrhages, and cottonwool spots (lesions), probably caused by diabetic retinopathy (aetiology), and good visual acuity (functional status).



Questions




What symptoms will this patient have?


The patient will be asymptomatic as the macula is spared.



How would you manage such a patient?




• Treat diabetes and associated hypertension


• Annual fundal examination.


The Early Treatment of Diabetic Retinopathy Study (ETDRS) has established that early peripheral (panretinal) argon laser photocoagulation is not indicated for mild to moderate non-proliferative retinopathy. Early treatment in the form of argon laser photocoagulation applied directly to leaking microaneurysms, as well as grid photocoagulation applied to diffuse areas of leakage and thickening, is highly beneficial.



Patient 2



Salient features



Examination




• Signs of background retinopathy with hard exudates or oedema of the macula.



Diagnosis


This patient has diabetic maculopathy, caused by the oedema and/or the hard exudates.



Questions




What symptoms may this patient have?


There will be a gradual impairment of central vision, such as difficulty in reading small print or seeing road signs.



Patient 3



Salient features



Examination




• Cottonwool spots


• Venous dilatation, beading, looping or sausage-like segmentation


• Arteriolar narrowing


• Haemorrhages: large dark blots


• Intraretinal microvascular abnormalities.



Diagnosis


This patient has preproliferative retinopathy, which is uncommon and is caused by retinal hypoxia.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Diabetic retinopathy

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