Diabetic Retinopathy (Coursework Sample)

Name:LUCABEN, ANGELICA R.
Topic: Diabetic Retinopathy
A. INTRODUCTION
Diabetic Retinopathy is the most common microvascular complication of diabetes mellitus and one of the leading causes of blindness in the industrialized world. The main cause of this is chronic hyperglycemia, however there are other risk factors for the development and progression of retinopathy such as systemic hypertension, hypercholesterolemia and smoking. The patient gradually develops over time and considered as an elective condition during the early stages, however if it has already progressed to visual loss then it can be an emergency. The management depends on the stage of the disease upon consultation, it can be managed as outpatient if caught early, and the patient may need to be admitted if otherwise.
The relative risk for developing diabetic retinopathy is higher in type 1 compared to type 2 and females have the higher incidence of developing the disease as compared to men. Early detection and timely treatment of diabetic retinopathy are essential for the prevention of permanent visual loss.
B. CHIEF COMPLAINT/S
Progressive loss of vision
* Patients in the early stages of diabetic retinopathy are usually asymptomatic, they only complain of symptoms in the later stages.
C. SIGNS AND SYMPTOMS
1 Symptoms
* Blurred vision
* Transition of vision sometimes from blurry to clear
* Seeing an increasing number of floaters
* Seeing blank or dark areas in your field of vision
* Poor night vision
* Losing vision
2 Signs
Microaneurysms


Retinal hemorrhages


Exudates


Cotton-wool spots


Venous beading


Neovascularization


D. DIAGNOSTIC WORK-UP
Fluorescein Angiography
A drop is used to dilate the pupils and a dye is injected into the vein on the patient’s arm. The dye can circulate into the eyes and may leak into the retina or stain the blood vessels if they are abnormal. This is used for an accurate guidance for laser treatments.


Optical Coherence Tomography
Provides an important additional information about the retina. Provides high resolution cross-sectional images of the retina, revealing its thickness and can show cysts or swelling. This can be done before and after treatment to determine effectivity.

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Dilated Eye Exam
Diabetic retinopathy can be diagnosed by this simple procedure. An eye drop is used to widen the pupils, allowing the examiner to visualize the retina perfectly and to check for different signs of abnormality and signs of diabetic retinopathy.


E. DEFINITIVE TREATMENT
GENERAL


Rationale

Patient Education

Critical, and it includes strict adherence to treatments and medications to optimize visual outcomes. This includes weight loss, counselling, and cessation of smoking if the need arises.

Diabetic, and/or hypertension and/or hypercholesterolemia control

The mainstay of treatment is to control hyperglycemia and blood pressure to slow and possibly stop the progression of the disease.

Ocular treatment depends on the location and severity of the retinopathy. Diabetic macular edema that is not clinically significant is usually monitored closely without treatment.
SPECIFICS

Anti-VEGF agents
(ranibizumab, aflibercept, or bevacizumab)

In center-involving macular edema, intravitreal injections can improve visual acuity and can maintain the improvement for over 5 years.
This regiment consists of a loading phase of 3-6 monthly injections until VA stabilizes followed by a long-term therapy at potentially longer intervals, either at fixed intervals, as required to treat recurrence of edema (treat and observe), or as determined to be adequate to prevent development of edema (treat and extend).
Dose:
Bevacizumab (Avastin); 1.25mg/0.05 mL
Ranibizumab (Lucentis): 0.5mg/0.05 mL
Aflibercept (Eylea): 2mg/0.05 mL

Panretinal laser photocoagulation (PRP)

Induces regression of new vessels and reduces the incidence of severe visual loss from proliferative diabetic retinopathy by 50%.
Laser treatment is reserved for clinically significant edema that is not center involving or in combination with an anti-VEGF agent in center-involving edema.

Vitrectomy

Removes vitreous hemorrhage and relieves vitreoretinal traction.
Early vitrectomy is indicated for type I diabetics with extensive vitreous hemorrhage and severe, active proliferation and poor vision in the contralateral eye, facilitating early visual rehabilitation.
It is also indicated for sight-threatening tractional retinal detachment and for rhegmatogenous retinal detachment complicating proliferative retinopathy.

Name:LUCABEN, ANGELICA R.Submitted to: Dr. Nicanor Sison
Group No. 12Date Submitted: August 8, 2021
Topic: Age Related Macular Degeneration, Wet Type
A. INTRODUCTION
Age-related macular degeneration (AMD) is a degenerative disorder affecting the macula. This affects the elderly and is the leading cause of irreversible blindness in the developed world. It is a complex multifactorial progressive disease and commonly affects the female gender, white race and smokers It is classified as dry or non-exudative, non-neovascular AMD and wet or exudative, neovascular AMD. The latter will be discussed in this paper.
The wet AMD is much less common than dry but is associated with more rapid progression to advanced sight loss. This is characterized by choroidal neovascularization (CNV), wherein choroidal new vessels may grow in a flat cartwheel or sea-fan configuration away from the site of entry beneath the RPE, giving rise to a fibrovascular or occult type. The new blood vessels may then bleed and leak fluid, causing the macula to bulge or lift up from its normally flat position, thus distorting or destroying central vision. Under these circumstances, vision loss may be rapid and severe.
Patients with late AMD in one eye, or even moderate vision loss due to non-advanced AMD in one eye have about 50% chance of developing advanced AMD in the other eye within 5 years. Therefore, if this condition is diagnosed earlier, it is indicated for early treatment and management, making the condition an emergency or semi-emergency and the patient may need to be admitted for treatment. The goal is to stop the progression of visual loss.
B. CHIEF COMPLAINT/S
Straight lines appear crooked or wavy
* The most common symptoms typical of onset of wet AMD are central visual blurring and distortion. But this is the most common chief complaint.
C. SIGNS AND SYMPTOMS
* SYMPTOMS
* Visual distortions
* Reduced central vision in one or both eyes
* Increased difficulty adapting to low light levels
* Increased blurriness of printed words
* Decreased intensity or brightness of colors
* Difficulty recognizing faces
* SIGNS
* Choroidal Neovascularization (CNV) itself may be identifiable as a gray-green or pinkish-yellow lesion.
* Associated medium-large drusen are a typical finding in the same or fellow eye
* Localized subretinal fluid, sometimes with cystoid macular edema.
* Intra or subretinal lipid deposition, sometimes extensive
* Hemorrhage is common (e.g. subretinal, preretinal/retrohyaloid, vitreous)
* There may be an associated serous, fibrovascular, drusenoid or hemorrhagic PED
* Retinal and subretinal cicatrization (disciform scar) in an evolved or treated lesion.
D. DIAGNOSTIC WORK-UP
Fluorescein Angiography
This was previously used to diagnose CNV and to plan and monitor the response to laser photocoagulation or PDT.
Indications:
* Diagnosis of CNV prior to committing to anti-VEGF treatment. It should be performed urgently on the basis of clinical suspicion
* As an adjunct to diagnosis of an alternative form of neovascular AMD such as PCV
* Exceptionally, localization for extrafoveal photocoagulation, or guidance for PDT

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