CC March 2017 Diabetic retinopathy

echoecho's version from 2018-04-11 03:40


Question Answer
What is the leading cause of blindness and vision impairment in the US?diabetic retinopathy
What % of DM type 1 and DM type 2 patients will develop DM retinopathy?75%; 50%
Why has the incidence of severe retinopathy in T1 DM decreased over the past several decades?because of improvements in the treatment of early stage retinopathy
List the factors that have been linked to diabetic retinopathy?1) diabetes severity 2) diabetic duration 3) presence of other complications (DM nephropathy, DM neuropathy) 4) HTN 5) anemia 6)dyslipidemia 7) family hx of retinopathy
What two things can be done to reduce the incidence of DM retinopathy and delay progression of the disease?1) improving glycemic control 2) improving blood pressure control
Name the retinal cell types that are affected in DM retinopathy?1) inner retinal neurons 2) Muller cells 3) astrocytes 4) pigment epithelium
What 2 sequelae occur early in the process and are mediated by cytokines?1) inflammation 2) oxidative stress
What stimulates retinal cells to produce vascular endothelial growth factor (VEGF) that causes the development of tortuous, poorly formed and permeable blood vessels?localized ischemia
In its earliest stages, DM retinopathy is referred to as what?nonproliferative diabetic retinopathy (NPDR)
Abnormalities in vascular integrity produce what?1) microaneurysms 2) intraretinal hemorrhages 3) cotton wool spots (yellow-white spots caused by retinal nerve fiber microinfarcts)
What does increased vascular permeability produce?1) retinal edema 2) hard exudates (deposits of lipid)
At later stages of NPDR (nonproliferative DM retinopathy), what happens to the retinal vessels?occlusion of retinal vessels that lead to impaired retinal perfusion and ischemia
When is proliferative retinopathy diagnosed?when there is neovascularization in response to widespread ischemia (new blood vessels are fragile and can bleed into the vitreous)
The presentation of DM retinopathy varies greatly and is based on what?1) location 2) severity 3) number of lesions
What will the patient note if the fovea is affected?decrease in central vision
What will the patient note with widespread peripheral retinal disease?may remain asymptomatic
*** List the way the American Diabetes Association recommends screening for diabetic retinopathy?1) patients with T1DM should have a comprehensive dilated eye exam w/in 5 years of dx 2) pts with T2DM should have a comprehensive, dilated eye exam at time of dx 3) if no retinopathy is found on repeat yearly exams and hyperglycemia is well controlled, a repeat exam may be performed every 2 years 4) if any degree of retinopathy is present, an annual comprehensive, dilated eye exam should be performed 5) women with T1DM or T2DM who become pregnant should be monitored for retinopathy during each trimester and followed closely during the first postpartum year
Once DM retinopathy has been diagnosed, what control is essential?1) glycemia control 2) BP control
What procedure is effective for the treatment of NPDR with significant macular edema?laser photocoagulation
*** What treatment has also been shown to reduce macular edema in patients with NPDR and to improve visual acuity?anti-VEGF (vacular endothelial growth factor), such as intravitreal injections of ranibizumab
In pts with proliferative retinopathy, what is the treatment?laser photocoagulation with anti-VEFG injections as useful adjuncts
Have intravitreal corticosteroids which target inflammation of DM retinopathy shown to be effective?no
When is surgery reserved for?complications of DM retinopathy (nonclearing vitreous hemorrhage and tractional retinal detachment)
*** SUMMARY = What is the leading cause of blindness and vision impairment in the US?diabetic retinopathy
*** SUMMARY = The risk of DM retinopathy can be minimized with adequate control of what?hyperglycemia and HTN
*** SUMMARY = What is the most effective therapy? the most effective adjunctive therapy for DM retinopathy?laser photocoagulation; injected anti-vascular endothelial growth factor