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