8eLlna deLachmenL

8eLlna deLachmenL
W 8eLlnal deLachmenL refers Lo Lhe separaLlon of
Lhe neurosensory reLlna from Lhe underlylng
reLlnal plgmenL eplLhellum Lo whlch normally
lL ls loosely aLLached
Lhe lmage shows a Lyplcal reddlsh horseshoe
Lear ln Lhe reLlna (arrow) wlLh bullous reLlnal
deLachmenL
khegmatogenous ret|na| detachment resulLs
from a Lear le a break ln Lhe reLlna
1ract|ona| ret|na| detachment resulLs from
LracLlon le from vlLreous sLrands LhaL exerL
Lenslle forces on Lhe reLlna
Lxudat|ve ret|na| detachment ls caused by fluld
8lood llplds or serous fluld accumulaLes
beLween Lhe neurosensory reLlna and Lhe
reLlnal plgmenL eplLhellum
LLlology
W khegmatogenous ret|na| detachment 1hls dlsorder
develops from an exlstloq bteok lo tbe tetloo
W 1ract|ona| ret|na| detachment 1hls develops from Lhe
Lenslle forces exerLed on Lhe reLlna by prereLlnal
flbrovascular sLrands especlally ln prollferaLlve reLlnal
dlseases such as dlabeLlc reLlnopaLhy
W Lxudat|ve ret|na| detachment 1he prlmary cause of
Lhls Lype ls Lhe breakdown of Lhe lnner or ouLer blood
reLlna barrler usually as a resulL of a vascular
dlsorder such as CoaLs' dlsease
SympLoms
etlool Jetocbmeot
W lootets
W losbloq llqbts
W 5boJow
uLllnl1lCn uLllnl1lCn
W W ket|nopathy ket|nopathy ls a general Lerm LhaL refers Lo ls a general Lerm LhaL refers Lo
some form of non some form of non lnflammaLory damage Lo lnflammaLory damage Lo
Lhe reLlna of Lhe eye lrequenLly reLlnopaLhy
ls an ocular manlfesLaLlon of sysLemlc dlsease
L1lCLCC? L1lCLCC?
W W dlabeLes dlabeLes dlabeLlc reLlnopaLhy dlabeLlc reLlnopaLhy
W W arLerlal hyperLenslon arLerlal hyperLenslon hyperLenslve hyperLenslve
reLlnopaLhy reLlnopaLhy
W W slckle cell anemla slckle cell anemla
W W reLlnal veln or arLery occluslon reLlnal veln or arLery occluslon
W W Many Lypes of reLlnopaLhy are progresslve and Many Lypes of reLlnopaLhy are progresslve and
may resulL ln may resulL ln
ulA8L1lC 8L1lnCA1P? ulA8L1lC 8L1lnCA1P?
W W SIGNS AND SM1CMS SIGNS AND SM1CMS
A A mlcrovascular mlcrovascular dlsease LhaL prlmarlly affecLs Lhe dlsease LhaL prlmarlly affecLs Lhe
caplllarles dlabeLes melllLus affecLs Lhe eye by caplllarles dlabeLes melllLus affecLs Lhe eye by
desLroylng Lhe vasculaLure ln Lhe con[uncLlva desLroylng Lhe vasculaLure ln Lhe con[uncLlva
reLlna and cenLral nervous sysLem aLlenLs may reLlna and cenLral nervous sysLem aLlenLs may
presenL wlLh hlsLorles of long presenL wlLh hlsLorles of long sLandlng ln[ecLed sLandlng ln[ecLed
bulbar con[uncLlvae along wlLh sysLemlc bulbar con[uncLlvae along wlLh sysLemlc
complalnLs of welghL loss desplLe larger Lhan complalnLs of welghL loss desplLe larger Lhan
normal appeLlLe ( normal appeLlLe (polyphasla polyphasla) abnormal LhlrsL ) abnormal LhlrsL
( (polydypsla polydypsla) and abnormally frequenL urlnaLlon ) and abnormally frequenL urlnaLlon
( (polyurla polyurla) )
W W llucLuaLlng vlsual aculLy secondary Lo unsLable blood sugar ls a llucLuaLlng vlsual aculLy secondary Lo unsLable blood sugar ls a
common ocular slgn Swelllng wlLhln Lhe crysLalllne lens resulLs ln common ocular slgn Swelllng wlLhln Lhe crysLalllne lens resulLs ln
large sudden shlfLs ln refracLlon as well as premaLure caLaracL large sudden shlfLs ln refracLlon as well as premaLure caLaracL
formaLlon Changes ln vlsual aculLy wlll depend upon Lhe severlLy formaLlon Changes ln vlsual aculLy wlll depend upon Lhe severlLy
and sLage of Lhe dlsease and sLage of Lhe dlsease
W W ln Lhe reLlna weakenlng of Lhe arLerloles and caplllarles may resulL ln Lhe reLlna weakenlng of Lhe arLerloles and caplllarles may resulL
ln Lhe characLerlsLlc appearance of ln Lhe characLerlsLlc appearance of lnLrareLlnal lnLrareLlnal doL and bloL doL and bloL
hemorrhages exudaLes hemorrhages exudaLes lnLrareLlnal lnLrareLlnal mlcrovascular mlcrovascular abnormallLles abnormallLles
(l8MA) (l8MA) mlcroaneurysms mlcroaneurysms edema and coLLon wool lnfarcLs edema and coLLon wool lnfarcLs
rollferaLlve dlabeLlc reLlnopaLhy ls Lhe resulL of severe vascular rollferaLlve dlabeLlc reLlnopaLhy ls Lhe resulL of severe vascular
compromlse and ls vlslble as compromlse and ls vlslble as neovascularlzaLlon neovascularlzaLlon of Lhe dlsc (nvu) of Lhe dlsc (nvu)
neovascularlzaLlon neovascularlzaLlon elsewhere (nvL) and elsewhere (nvL) and neovascularlzaLlon neovascularlzaLlon of Lhe of Lhe
lrls (nvl or lrls (nvl or rubeosls rubeosls lrldes lrldes) neurologlcal compllcaLlons lnclude ) neurologlcal compllcaLlons lnclude
palsles of Lhe Lhlrd fourLh and slxLh cranlal nerves as well as palsles of Lhe Lhlrd fourLh and slxLh cranlal nerves as well as
dlabeLlc dlabeLlc papllllLls papllllLls and faclal nerve paralysls and faclal nerve paralysls
A1CPlSlCLCC? A1CPlSlCLCC?
W W 8lochemlsLry lnvolvlng Lhe formaLlon of 8lochemlsLry lnvolvlng Lhe formaLlon of sorblLol sorblLol plays a plays a
role ln Lhe desLrucLlon of role ln Lhe desLrucLlon of perlcyLes perlcyLes whlch are cells LhaL whlch are cells LhaL
supporL Lhe vascular endoLhellum As Lhe supporLlve supporL Lhe vascular endoLhellum As Lhe supporLlve
perlcyLes perlcyLes perlsh caplllary endoLhellum becomes perlsh caplllary endoLhellum becomes
compromlsed resulLlng ln Lhe vascular leakage of compromlsed resulLlng ln Lhe vascular leakage of
blood proLeln and llpld 1hls ln comblnaLlon wlLh blood proLeln and llpld 1hls ln comblnaLlon wlLh
Lhlckened glucose Lhlckened glucose laden blood produces vascular laden blood produces vascular
lnsufflclency caplllary lnsufflclency caplllary nonperfuslon nonperfuslon reLlnal hypoxla reLlnal hypoxla
alLered sLrucLure and decreased funcLlon 1he alLered sLrucLure and decreased funcLlon 1he
formaLlon and release of formaLlon and release of vasoprollferaLlve vasoprollferaLlve facLors facLors
whlch play a role ln Lhe genesls of reLlnal whlch play a role ln Lhe genesls of reLlnal
neovascularlzaLlon neovascularlzaLlon are poorly undersLood are poorly undersLood
SympLoms SympLoms
W W SpoLs floaLlng ln your vlslon SpoLs floaLlng ln your vlslon
W W 8lurred vlslon 8lurred vlslon
W W uark sLreaks or a red fllm LhaL blocks your uark sLreaks or a red fllm LhaL blocks your
vlslon vlslon
W W oor nlghL vlslon oor nlghL vlslon
W W vlslon loss vlslon loss
A c|ass|f|cat|on of d|abet|c ret|nopathy A c|ass|f|cat|on of d|abet|c ret|nopathy
W W A useful classlflcaLlon accordlng Lo Lhe A useful classlflcaLlon accordlng Lo Lhe
Lypes of leslons deLecLed on Lypes of leslons deLecLed on fundoscopy fundoscopy ls ls
as follows as follows
W W Non Non pro||ferat|ve d|abet|c ret|nopathy pro||ferat|ve d|abet|c ret|nopathy
(NDk) (NDk)
M||d non M||d non pro||ferat|ve d|abet|c ret|nopathy pro||ferat|ve d|abet|c ret|nopathy
Mlcroaneurysms Mlcroaneurysms
uoL and bloL haemorrhages uoL and bloL haemorrhages
Pard ( lnLra Pard ( lnLra reLlnal ) exudaLes reLlnal ) exudaLes
Moderate Moderate to to severe non severe non pro||ferat|ve d|abet|c ret|nopathy pro||ferat|ve d|abet|c ret|nopathy
1he above leslons usually wlLh exacerbaLlon plus 1he above leslons usually wlLh exacerbaLlon plus
CoLLon CoLLon wool spoLs wool spoLs
venous beadlng and loops venous beadlng and loops
lnLrareLlnal lnLrareLlnal mlcrovascular mlcrovascular abnormallLles ( l8MA ) abnormallLles ( l8MA )
W W ro||ferat|ve ro||ferat|ve
d|abet|c d|abet|c
ret|nopathy ret|nopathy
neovascularlzaLlon neovascularlzaLlon of Lhe of Lhe
reLlna opLlc dlsc or lrls reLlna opLlc dlsc or lrls
llbrous Llssue adherenL llbrous Llssue adherenL
Lo vlLreous face of reLlna Lo vlLreous face of reLlna
8eLlnal deLachmenL 8eLlnal deLachmenL
vlLreous haemorrhage vlLreous haemorrhage
re reLlnal haemorrhage re reLlnal haemorrhage
W W Macu|opathy Macu|opathy
Cllnlcally slgnlflcanL Cllnlcally slgnlflcanL
macular oedema (CSML ) macular oedema (CSML )
lschaemlc lschaemlc MaculopaLhy MaculopaLhy
Non Non pro||ferat|ve d|abet|c ret|nopathy (NDk) pro||ferat|ve d|abet|c ret|nopathy (NDk)
otton Woo| Spots otton Woo| Spots
ate non pro||ferat|ve changes ate non pro||ferat|ve changes
W W lnLra lnLra reLlnal reLlnal mlcrovascular mlcrovascular abnormallLles ( l8MA) are abnormallLles ( l8MA) are
abnormal dllaLed reLlnal caplllarles or may represenL abnormal dllaLed reLlnal caplllarles or may represenL
lnLrareLlnal lnLrareLlnal neovacularlzaLlon neovacularlzaLlon whlch has noL whlch has noL
breached Lhe lnLernal llmlLlng membrane of Lhe breached Lhe lnLernal llmlLlng membrane of Lhe
reLlna reLlna
W W 1hey lndlcaLe severe non 1hey lndlcaLe severe non prollferaLlve dlabeLlc prollferaLlve dlabeLlc
reLlnopaLhy LhaL may rapldly progress Lo reLlnopaLhy LhaL may rapldly progress Lo
prollferaLlve reLlnopaLhy venous beadlng has an prollferaLlve reLlnopaLhy venous beadlng has an
appearance resembllng sausage appearance resembllng sausage shaped dllaLaLlon of shaped dllaLaLlon of
Lhe reLlnal velns lL ls anoLher slgn of severe non Lhe reLlnal velns lL ls anoLher slgn of severe non
prollferaLlve dlabeLlc reLlnopaLhy prollferaLlve dlabeLlc reLlnopaLhy
ate non pro||ferat|ve changes ate non pro||ferat|ve changes
ro||ferat|ve d|abet|c ret|nopathy ro||ferat|ve d|abet|c ret|nopathy
W W 8eLlnal lschaemla due Lo wldespread caplllary non perfuslon resulLs ln 8eLlnal lschaemla due Lo wldespread caplllary non perfuslon resulLs ln
Lhe producLlon of vasoprollferaLlve subsLances and Lo Lhe Lhe producLlon of vasoprollferaLlve subsLances and Lo Lhe
developmenL of neovascularlzaLlon neovascularlzaLlon can lnvolve developmenL of neovascularlzaLlon neovascularlzaLlon can lnvolve
Lhe reLlna opLlc dlsc or Lhe lrls Lhe reLlna opLlc dlsc or Lhe lrls% tobeosls ltlJls) % tobeosls ltlJls)
W W 8ubeosls lrldls ls a slgn of severe prollferaLlve dlsease lL may cause 8ubeosls lrldls ls a slgn of severe prollferaLlve dlsease lL may cause
lnLracLable glaucoma lnLracLable glaucoma
W W 8leedlng from fraglle new vessels lnvolvlng Lhe reLlna or opLlc dlsc can 8leedlng from fraglle new vessels lnvolvlng Lhe reLlna or opLlc dlsc can
resulL ln vlLreous or reLlnal haemorrhage 8eLlnal damage can resulL resulL ln vlLreous or reLlnal haemorrhage 8eLlnal damage can resulL
from perslsLenL vlLreous haemorrhage from perslsLenL vlLreous haemorrhage
W W re re reLlnal haemorrhages are ofLen assoclaLed wlLh reLlnal reLlnal haemorrhages are ofLen assoclaLed wlLh reLlnal
neovascularlzaLlon Lhey may dramaLlcally reduce vlslon wlLhln a few neovascularlzaLlon Lhey may dramaLlcally reduce vlslon wlLhln a few
mlnuLes mlnuLes
ro||ferat|ve d|abet|c ret|nopathy ro||ferat|ve d|abet|c ret|nopathy
SLages of dlabeLlc reLlnopaLhy (1) SLages of dlabeLlc reLlnopaLhy (1)
Stage Principal clinical findings
Early stage
Mild NPDR
Retinal vascular microanevrysms and
blot hemorrages
Increased retinal vascular permeability
Cotton wool spots
iddle stages
Moderate NPDR
Severe NPDR
Very severe NPDR
Venous caliber changes or beading
Intraretinal microvascular abnormalities
Retinal capillary loss
Retinal ischemia
Extensive intraretinal hemorrhages and
microanevrysms
nu8 non prollferaLlve dlabeLlc reLlnopaLhy
SLages of dlabeLlc reLlnopaLhy (2) SLages of dlabeLlc reLlnopaLhy (2)
Stage Principal clinical findings
Advanced stage
PDR
New vessel proliIeration at the optic disk
or elsewhere in the retina
Neovascularization oI the iris,
neovascular glaucoma
Preretinal and vitreaous hemorrhage
Fibrovascular proliIeration
Retinal traction, retinal tears, retinal
detachment
u8 prollferaLlve dlabeLlc reLlnopaLhy
Lxams and 1ests Lxams and 1ests
W W Color vlslon Color vlslon
W W LxamlnaLlon of Lhe reLlna by LxamlnaLlon of Lhe reLlna by ophLhalmoscopy ophLhalmoscopy afLer Lhe puplls have afLer Lhe puplls have
been dllaLed been dllaLed
W W lluoresceln lluoresceln anglography anglography
W W lnLraocular pressure lnLraocular pressure
W W MeasuremenL of Lhe elecLrlcal acLlvlLy ln Lhe reLlna MeasuremenL of Lhe elecLrlcal acLlvlLy ln Lhe reLlna
( (elecLroreLlnogram elecLroreLlnogram) )
W W upll reflex response upll reflex response
W W 8efracLlon LesL 8efracLlon LesL
W W 8eLlnal phoLography 8eLlnal phoLography
W W Slde vlslon LesL (vlsual fleld LesL) Slde vlslon LesL (vlsual fleld LesL)
W W SllL lamp examlnaLlon SllL lamp examlnaLlon
W W vlsual aculLy vlsual aculLy
Coals of managemenL (1) Coals of managemenL (1)
ldenLlfy lndlvlduals aL rlsk of developlng dlabeLlc ldenLlfy lndlvlduals aL rlsk of developlng dlabeLlc
reLlnopaLhy reLlnopaLhy
Assure approprlaLe sysLemlc Assure approprlaLe sysLemlc glycemlc glycemlc conLrol conLrol
rovlde approprlaLe llfelong evaluaLlon of rovlde approprlaLe llfelong evaluaLlon of
reLlnopaLhy progresslon reLlnopaLhy progresslon
rovlde Lherapy Lo lndlvlduals aL rlsk of vlsual loss rovlde Lherapy Lo lndlvlduals aL rlsk of vlsual loss
lello ulobetes cote 1998
Coals of managemenL (2) Coals of managemenL (2)
Mlnlmlze Lhe assoclaLed vlsual and funcLlonal slde Mlnlmlze Lhe assoclaLed vlsual and funcLlonal slde
effecLs of Lhls Lherapy effecLs of Lhls Lherapy
rovlde rehablllLaLlon for Lhose wlLh vlsual loss rovlde rehablllLaLlon for Lhose wlLh vlsual loss
from Lhe dlsease from Lhe dlsease
LducaLe and lnvolve Lhe paLlenLs ln Lhe LducaLe and lnvolve Lhe paLlenLs ln Lhe
managemenL of Lhelr dlsease managemenL of Lhelr dlsease
lello ulobetes cote 1998
SelecLed LreaLmenL efflcacy resulLs SelecLed LreaLmenL efflcacy resulLs
%reatment Indication Efficacy
Focal laser
photocoagulation
CSME 50 reduction in moderate
visual loss aIter 3 years
Scatter photocoagulation High-risk PDR
Development oI
high risk PDR
60 reduction in severe visual
loss aIter 3 years
87 reduction in severe visual
loss aIter 3 years
90 reduction in legal blindness
aIter 5 years
Vitrectomy Severe PDR and
severe vitreous
hemorrhage
60 increased chance oI 20/40
or better aIter 2 years
lello ulobetes cote 1998
ManagemenL recommendaLlons ManagemenL recommendaLlons
iabetic retinopathy
level
CSE Panretinal laser
photocoagulation
Focal laser
photocoagulation
None-Minimal NPDR No No No
Yes No Possible
Mild-Moderate NPDR No No No
Yes No Probable
Severe-Very severe NPDR No Possible No
Yes Possible* Yes*
Less than high-risk PDR No Probable No
Yes Probable* Yes*
High risk PDR No Yes No
Yes Yes* Yes*
CSML cllnlcally slgnlflcanL macular edema
*LreaLmenL of CSML should be performed before panreLlnal phoLocoagulaLlon
lnlLlal LreaLmenL Lo prevenL vlsual loss lnlLlal LreaLmenL Lo prevenL vlsual loss
Complication threatening vision Common inital treatment
Vitreaous hemorrhage CareIull observation or vitrectomy
Traction and/or retinal detachment Vitrectomy
Traction distorting macula Vitrectomy
Neovascular glaucoma Panretinal photocoagulation and/or
cryotherapy and intraocular pressure
management
ypertens|ve ket|nopathy
ypertens|ve ket|nopathy ypertens|ve ket|nopathy
ueflnlLlon ueflnlLlon
W W PyperLenslve reLlnopaLhy PyperLenslve reLlnopaLhy
ls a condlLlon ls a condlLlon
characLerlzed by a characLerlzed by a
specLrum of reLlnal specLrum of reLlnal
vascular slgns ln people vascular slgns ln people
wlLh elevaLed blood wlLh elevaLed blood
pressure pressure
Symptoms Symptoms
W W Peadaches Peadaches
W W vlsual dlsLurbances and someLlmes sudden vlsual dlsLurbances and someLlmes sudden
vlslon loss vlslon loss
athophys|o|ogy athophys|o|ogy
W W ypertens|on |eads to a |ay|ng down of cho|estero| |nto the tun|ca ypertens|on |eads to a |ay|ng down of cho|estero| |nto the tun|ca |nt|ma |nt|ma of of
med|um and |arge arter|es med|um and |arge arter|es
W W 1h|s |eads to an overa|| reduct|on |n the |umen s|ze of these vesse|s In 1h|s |eads to an overa|| reduct|on |n the |umen s|ze of these vesse|s In
arter|o|osc|eros|s hypertens|on |eads to foca| c|osure of the ret|na| arter|o|osc|eros|s hypertens|on |eads to foca| c|osure of the ret|na|
m|crovascu|ature m|crovascu|ature
W W 1h|s g|ves r|se to 1h|s g|ves r|se to m|cro|nfarcts m|cro|nfarcts (cotton woo| spots) and superf|c|a| hemorrhages (cotton woo| spots) and superf|c|a| hemorrhages
W W Arter|o|osc|erot|c Arter|o|osc|erot|c changes |n the ret|na| m|crovascu|ature pers|st even w|th the changes |n the ret|na| m|crovascu|ature pers|st even w|th the
reduct|on of system|c b|ood pressure reduct|on of system|c b|ood pressure
W W owever hypertens|ve ret|nopathy changes reso|ve over t|me w|th the reduct|on owever hypertens|ve ret|nopathy changes reso|ve over t|me w|th the reduct|on
of system|c b|ood pressure (8) of system|c b|ood pressure (8)
W W otton woo| spots deve|op |n 24 to 48 hours w|th the e|evat|on of 8 and reso|ve otton woo| spots deve|op |n 24 to 48 hours w|th the e|evat|on of 8 and reso|ve
|n two to 10 weeks w|th the |ower|ng of 8 |n two to 10 weeks w|th the |ower|ng of 8
W W A macu|ar star deve|ops w|th|n severa| weeks of the deve|opment of e|evated 8 A macu|ar star deve|ops w|th|n severa| weeks of the deve|opment of e|evated 8
and reso|ves w|th|n months to years after the 8 |s reduced and reso|ves w|th|n months to years after the 8 |s reduced
W W ap|||edema ap|||edema deve|ops w|th|n days to weeks of |ncreased 8 and reso|ves w|th|n deve|ops w|th|n days to weeks of |ncreased 8 and reso|ves w|th|n
weeks to months fo||ow|ng 8 |ower|ng weeks to months fo||ow|ng 8 |ower|ng
|ass|f|cat|on of |ass|f|cat|on of Iundus Iundus hanges hanges
|n Arter|a| ypertens|on |n Arter|a| ypertens|on
W W Stage Stage II
W W normal or wldened arLerlolar callber normal or wldened arLerlolar callber
W W 8rlghLer reflexes on arLerloles 8rlghLer reflexes on arLerloles
W W vascular dlsLenslon and vascular dlsLenslon and LorLuoslLy LorLuoslLy
W W no no parenchymal parenchymal changes changes
W W ArLerlosclerosls of varlable severlLy ArLerlosclerosls of varlable severlLy
W W Pypervolemlc Pypervolemlc hyperLenslon hyperLenslon
Stage II Stage II
ArLerloles generallzed narrowlng ln callber ArLerloles generallzed narrowlng ln callber
Clrcumscrlbed areas of narrowed callber Clrcumscrlbed areas of narrowed callber
lncreased and lrregular reflexes lncreased and lrregular reflexes
aramacular aramacular venules venules dlsLended and LorLuous dlsLended and LorLuous
slgn slgn of venous sLasls of venous sLasls
lsolaLed caplllarles vlslble (caplllary lsolaLed caplllarles vlslble (caplllary ecLasla ecLasla) )
ln cenLral reLlna and on Lhe opLlc dlsk ln cenLral reLlna and on Lhe opLlc dlsk
Pyperemla of Lhe opLlc dlsks Pyperemla of Lhe opLlc dlsks
llne reLlnal hemorrhages llne reLlnal hemorrhages
Stage III ypertens|ve ret|nopathy Stage III ypertens|ve ret|nopathy
Cenerallzed narrowlng of Lhe Cenerallzed narrowlng of Lhe
arLerloles arLerloles
ArLerloles appear Lhln and ArLerloles appear Lhln and
Lhreadllke ln places Lhreadllke ln places
SegmenLal or rosary SegmenLal or rosary llke llke
consLrlcLlons consLrlcLlons
8rlghL and lrregular reflexes 8rlghL and lrregular reflexes
SlegrlsL's SlegrlsL's sLreaks and obllLeraLed sLreaks and obllLeraLed
vessels vessels
CoLLon CoLLon wool spoLs wool spoLs
PardexudaLes PardexudaLes
Macular sLar Macular sLar
8eLlnal hemorrhages 8eLlnal hemorrhages
CpLlc dlsk CpLlc dlsk edema edema
Stage IV Severe hypertens|ve ret|nopathy Stage IV Severe hypertens|ve ret|nopathy
Changes as ln sLage lll coverlng Lhe enLlre Changes as ln sLage lll coverlng Lhe enLlre
fundus fundus
8llaLeral severe 8llaLeral severe papllledema papllledema
8eLlnal edema 8eLlnal edema
LxudaLlve LxudaLlve reLlnal deLachmenL reLlnal deLachmenL
|ass|f|cat|on of ypertens|ve ket|nopathy on the 8as|s of kecent opu|at|on8ased Data
,llJ nypetteoslve etloopotby ,llJ nypetteoslve etloopotby
,oJetote ,oJetote nlpetteoslve nlpetteoslve etloopotby etloopotby
,ollqooot nypetteoslve etloopotby ,ollqooot nypetteoslve etloopotby
Lxams and 1esLs Lxams and 1esLs
W W 8lood pressure 8lood pressure
W W lluoresceln lluoresceln anglography anglography
W W CphLhalmoscoplc CphLhalmoscoplc examlnaLlon whlch can examlnaLlon whlch can
show changes even lf you have no sympLoms show changes even lf you have no sympLoms
1reaLmenL 1reaLmenL
W W ConLrol of hlgh blood pressure (hyperLenslon) ConLrol of hlgh blood pressure (hyperLenslon)
W W Lnalaprll or hydrochloroLhlazlde Lnalaprll or hydrochloroLhlazlde
rognosls rognosls
W W aLlenLs wlLh grade 4 (severe hyperLenslve aLlenLs wlLh grade 4 (severe hyperLenslve
reLlnopaLhy) frequenLly also have hearL and reLlnopaLhy) frequenLly also have hearL and
kldney compllcaLlons of hlgh blood pressure kldney compllcaLlons of hlgh blood pressure
1he reLlna wlll generally recover well lf Lhe 1he reLlna wlll generally recover well lf Lhe
blood pressure ls conLrolled buL some blood pressure ls conLrolled buL some
paLlenLs wlLh grade 4 hyperLenslve paLlenLs wlLh grade 4 hyperLenslve
reLlnopaLhy wlll have permanenL damage Lo reLlnopaLhy wlll have permanenL damage Lo
Lhe opLlc nerve or macula Lhe opLlc nerve or macula
osslble CompllcaLlons osslble CompllcaLlons
W W CompllcaLlons assoclaLed wlLh hlgh blood CompllcaLlons assoclaLed wlLh hlgh blood
pressure pressure
W W lrreverslble damage Lo Lhe opLlc nerve or lrreverslble damage Lo Lhe opLlc nerve or
macula resulLlng ln vlslon problems macula resulLlng ln vlslon problems
1PAnk ?Cu 1PAnk ?Cu
cotton woo/ 5pots cotton woo/ 5pots
P PCoLLon wool spoLs resulL from occluslon of reLlnal CoLLon wool spoLs resulL from occluslon of reLlnal
pre pre caplllary arLerloles supplylng Lhe nerve flbre caplllary arLerloles supplylng Lhe nerve flbre
layer wlLh concomlLanL swelllng of local nerve flbre layer wlLh concomlLanL swelllng of local nerve flbre
axons Also called sofL exudaLes or nerve flbre axons Also called sofL exudaLes or nerve flbre
layer lnfarcLlons Lhey are whlLe fluffy leslons ln Lhe layer lnfarcLlons Lhey are whlLe fluffy leslons ln Lhe
nerve flbre layer nerve flbre layer lluoresceln lluoresceln anglography shows no anglography shows no
caplllary perfuslon ln Lhe area of Lhe sofL caplllary perfuslon ln Lhe area of Lhe sofL exudaLe exudaLe
1hey are very common ln u8 especlally lf Lhe 1hey are very common ln u8 especlally lf Lhe
paLlenL ls also hyperLenslve paLlenL ls also hyperLenslve