RETINOPATHY

Sandi I1117009

DefiniTion
Retinopathy is a disorder of the retina that is not caused by inflammation

etiology
Anemia Diabetes mellitus Hipotention Hipertention Leucemia Medications Radiation

ANEMIA retinopathy

ANEMIA retinopathy
Can see changes including bleeding and superficial papil edema

Anemia
Severe Anoxia

Retinal Infark
Anemia Retinopathy

ANEMIA retinopathy

Diabetic retinopathy

Definition
Diabetic retinopathy is a progressive dysfunction of the retinal vasculature caused by chronic hyperglycemia.

epidemiology
Diabetic retinopathy remains the number one cause of new blindness in most industrialized countries 12% cases of blindness caused by diabetic retinopathy Usually affects patient aged 20-46 years This risk is rare in children under the age of 10 years and increase after puberty

epidemiology
The best predictor of diabetic retinopathy is the duration of the disease.
Patients who have had type 1 diabetes
for 5 years or less rarely show any evidence of diabetic retinopathy However, 27% of those who have had diabetes for 510 years and 7190% of those who have had diabetes for longer than 10 years have diabetic retinopathy. After 2030 years, the incidence rises to 95%, and about 3050% of these patients have proliferative diabetic retinopathy (PDR).

epidemiology
Yanko et al. described the prevalence of retinopathy in patients with type 2 diabetes.
They found that the prevalence of retinopathy 1113 years after the onset of type 2 diabetes was 23%; after 16 or more years, it was 60%; and 11 or more years after the onset, 3% of the patients had PDR. Klein et al. found that 10 years after the diagnosis of type 2 diabetes, 67% of patients

pathogenesis
Aldolase reductase
glucose Aldose reductase galactose galactitol sorbitol

pathogenesis
Vasoproliferative Factors

pathogenesis

Platelets and Blood Viscosity

Diabetes is associated with abnormalities of platelet function It has been postulated that platelet abnormalities or alterations in blood viscosity in diabetics may contribute to diabetic retinopathy by causing focal capillary occlusion and focal areas of ischemia in the retina which, in turn, contribute to the development of diabetic retinopathy.

Stages and ocular Manifestation

Stage of retinopaty
Nonproliferative diabetic retinopathy

Retinal changes
Microaneurysms. Intraretinal hemorrhages Lipid deposits in the retina (hard exudates) Retinal edema Venous bleading Excessive hemorrhages Cotton-wool spots (nerve fiber infarctions with soft exudates) Intraretinal microvascular anomalies Preretinal neovascularization Vitreous hemorrhage Tractional retinal detachment (due to traction of vitreous scarring) Rubeosis iridis (neovascularization of the iris that can occlude the angle on the anterior chamber; this entails the risk of acute secondary angle closure glaucoma)

Proliferative diabetic retinopathy

Stages and ocular Manifestation

Mild Nonproliferative Retinopathy. At this earliest stage, microaneurysms occur Moderate Nonproliferative Retinopathy. As the disease progresses, some blood vessels that nourish the retina are blocked Severe Nonproliferative Retinopathy. Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment

stages
The earliest stage of diabetic retinopathy is nonproliferative (NPDR). In some patients, there is progression to proliferative retinopathy (PDR)

symptoms
Often there are no symptoms in the early stages of the disease, nor is there any pain Blurred vision may occur when the maculathe part of the retina that provides sharp central visionswells from leaking fluid. This condition is called macular edema If new blood vessels grow on the surface of the retina, they can bleed into the eye

 Retinopathy is usually found bilateral, symmetrical and progressive, with three forms:
Back ground: mikroaneurysm, bleeding spots and dots, and edema sirsinata Makulopati: retinal edema and macular dysfunction Proliferation: vascularization of the retina and the glass body

diagnose
Patient history to determine vision difficulties experienced by the patient, presence of diabetes, and other general health concerns that may be affecting vision Visual acuity measurements to determine the extent to which central vision has been affected Refraction to determine the need for changes in an eyeglass prescription

diagnose
Supplemental testing may include: Retinal photography to document current status of the retina Fluorescein angiography to evaluate abnormal blood vessel growth The presence of rubeosis iridis is confirmed or excluded in slit-lamp examination

diagnose
Conditions that may aggravate diabetic retinopathy
Juvenile diabetes and pregnancy Arteriosclerosis Hiperlipoproteinemi Arterial hypertension Hypoglycemia or trauma Cigarette Smoking

Treatment
Nonproliferative diabetic retinopathy, no treatment is needed, unless have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol

Treatment
Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels to try to seal the leaks

Treatment
If the bleeding is severe, may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye.

hypotensIVE retinopathy

hypotensIVE Retinopathy
Retinal disorders decrease in blood pressure:
Retinal arteriolar and venous dilatation Ischemic optic nerve, retina and choroid due to hypoperfusion Neovascularization, glaucoma and retinitis in chronic hypotension

HYPERTENSIVE retinopathy

definition
CHRONIC HYPERTENSIVE RETINOPATHY Definition: Retinal vascular changes occurring from chronically elevated systemic arterial hypertension MALIGNANT ACUTE HYPERTENSIVE RETINOPATHY Definition: Retinal, choroidal, and optic nerve changes secondary to acutely elevated systemic arterial blood pressure

HYPERTENSIVE RETINOPATHY
Category* Normal High-normal Hypertension Stage 1 Stage 2 Stage 3 Stage 4

Systolic Blood Pressure (mmHg) <130 130139 140159 160179 180209 210

Diastolic Blood Pressure (mmHg) <85 8589 9099 100109 110119 120

 Retinal vascular response and other retinal changes seen in hypertension are variable and depend on several factors The most important factors are the rate and degree of hypertension and the baseline condition of the retinal vasculature Concomitant diseases, such as diabetes or renal or connective tissue disorders also play a role in the severity of findings.

ARTERIOSCLEROTIC CHANGES

The changes seen in the fundus secondary to hypertension

ARTERIOSCLEROTIC CHANGES

arteriovenous nicking

 The clinical features of hypertensive choroidopathy include the following:

Elschnig's spots and Siegrist's spots (RPE and choroidal infarcts) Subretinal exudates Serous retinal detachments RPE depigmentation (chronic) Choroidal sclerosis

 Clinical Findings in Neuropathy

Optic disc edema Optic disc pallor Optic disc ischemia

KEITH-WAGENER-BARKER CLASSIFICATION
Group 1 Mild-to-moderate narrowing or sclerosis of the arterioles Moderate to marked narrowing of the arterioles Local and/or generalized narrowing of arterioles Exaggeration of the light reflex Arteriovenous crossing changes Retinal arteriolar narrowing and focal constriction Retinal edema Cotton-wool patches Hemorrhage As for Group 3, plus papilledema

Group 2

Group 3

Group 4

SCHEIE CLASSIFICATION
Stage Characteristics HYPERTENSION

Grade I
Grade II

Barely detectable arteriolar narrowing

Obvious arteriolar narrowing with focal irregularities Grade 2 plus retinal hemorrhages and/or exudates Grade 3 plus papilledema

Grade III
Grade IV

SCHEIE CLASSIFICATION
Stage Characteristics ARTERIOLAR SCLEROSIS
Widening of arteriole reflexes Arteriovenous crossing sign Copper-wire arteries (copper colored arterial reflex) Silver-wire arteries (silver colored arterial reflex)

Grade I Grade II Grade III Grade IV

Symptoms
Most people with hypertensive retinopathy do not have symptoms until late in the disease. Malignant hypertension may cause the following sudden symptoms, and should be considered a medical emergency:
Double vision or dim vision Headaches Visual disturbances, and sometimes sudden vision loss

diagnosis
Hypertensive retinopathy is a clinical diagnosis made when the characteristic fundus findings are visualized on slit-lamp biomicroscopy in a patient with systemic arterial hypertension. Fluorescein angiography may be used, but it is not crucial in the diagnosis. Angiographic findings as described earlier are more common in malignant hypertension.

Differential Diagnosis of Chronic Hypertensive Retinopathy Diabetic retinopathy Retinal venous obstruction Hyperviscosity syndromes Congenital hereditary retinal arterial tortuosity Ocular ischemic syndrome Radiation retinopathy

Treatment
Controlling high blood pressure (hypertension) is the only treatment for hypertensive retinopathy.

Prognosis
Patients with grade 4 (severe hypertensive retinopathy) often have heart and kidney complications of high blood pressure. They are also at higher risk for stroke The retina will generally recover if the blood pressure is controlled. However, some patients with grade 4 hypertensive retinopathy will have permanent damage to the optic nerve or macula

Complications
Complications associated with high blood pressure Irreversible damage to the optic nerve or macula, resulting in vision problems
Central or branch artery occlusion Central or branch vein occlusion Macroaneurysms Epiretinal membrane Retinal neovascularization

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