hypertensive retinopathy and diabetic retinopathy

HYPERTENSIVERETINOPATHY

- DR.AKIF A.B

NORMAL RETINA

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 .

HYPERTENSIVERETINOPATHY

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

GRADE 1 : Tortuosity of retinal arteries and silver wiring .

GRADE-1

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

GRADE-2

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

GRADE-3

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

GRADE-4

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

DIABETIC RETINOPATHY

- DR.AKIF A.B

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)

Category 1 : Background DR : micro-aneurysm

CATEGORY-1

Category 2 : Moderate NPDR – multiple haemorrhages

CATEGORY-2

Category 3 : Severe NPDR : haemorrhages and exudate .

CATEGORY-3

Category 4 : Proliferative DR : neovascularization

CATEGORY-4

1) 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 :

Scatter treatment

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