Hypertensive retinopathy and diabetic retinopathy

Hypertensive retinopathy and diabetic retinopathy have been discussed here in a simplified manner to help u understand the topic well.....Do make use of it

1. HYPERTENSIVE RETINOPATHY - DR.AKIF A.B

2. NORMAL RETINA

3. Hypertensive retinopathy (HR)  is a complication of Htn that leads to damage to the retina and retinal circulation due to high BP . Usually they are asymptomatic but may present with decreased vision or headache . HYPERTENSIVE RETINOPATHY

4. It is grade based on Keith-Wagener Barker (KWB) system : GRADE 1 : Tortuosity (twisting) of retinal arteries with increased reflectiveness (silver wiring) GRADE 2 : Grade 1 + Arteriovenous napping (thickened retinal arteries pass over retinal veins) GRADE 3 : Grade 2 + flamed shape haemorrhage and cotton wool exudates (due to small infarct) GRADE 4 : Grade 3 + papilloedema (blurry margin of the optic disc) HYPERTENSIVE RETINOPATHY

5. GRADE 1 : Tortuosity of retinal arteries and silver wiring . GRADE-1

6. GRADE 2 : G1 + AV nipping (arrow – artery cross over onto vein) . GRADE-2

7. GRADE 3 : G2 + flame-shaped haemorrhage and cotton wool exudate (whitish) . GRADE-3

8. GRADE 4 : G3 + papilloedema (picture below only showing different between normal optic disc and papilloedema ) GRADE-4

9. Prevent , limit and reverse target organ damage by lowering patient’s BP level with anti hypertensive drug treatment and reduce the risk for cerebrovascular disease and death . Treatment for HR

10. DIABETIC RETINOPATHY - DR.AKIF A.B

11. Macular Oedema (can occur at any stage but commonly in Proliperative Stage , blood vessels leak fluids into macula) DIABETIC RETINOPATHY Category 1 Mild Non Proliperative Retinopathy (Background DR) presence of micro-aneurysm – a dot smaller than blood vessels) Category 2 Moderate Non Proliperative Retinopathy presence of multiple retinal haemorrhage Category 3 Severe Non Proliperative Retinopathy started to form new vessles with exudate formation Category 4 Proliferative Retinopathy neovascularization (fragile new vessels)

12. Category 1 : Background DR : micro-aneurysm CATEGORY-1

13. Category 2 : Moderate NPDR – multiple haemorrhages CATEGORY-2

14. Category 3 : Severe NPDR : haemorrhages and exudate . CATEGORY-3

15. Category 4 : Proliferative DR : neovascularization CATEGORY-4

16. Scatter laser treatment – to shrink abnormal blood vessels , reduce O2 supply to retina and increase supply of O2 to macula 2) Vascular Endothelial Growth Factor (VEGF) injections – reduction of new blood vessels 3) Vitrectomy surgery : removal of blood flow in vitreous humour and replace with sterile normal saline 4) Focal laser treatment for macula oedema – reduce leakage of fluid and reduce the amount of fluid in retina TREATMENT :

17. Scatter treatment

18. Laser treatment does not cure the retinopathy but reducing the severity of the visual disturbances . The control of blood sugar , dietary control and regular exercise still needed . Focal laser treatment for macula oedema