Today's date is 18/11/2012. As you all can see in newspaper and internet there are a lots of news about ours brothers and sisters suffering a lots at Gaza because of the cruelty Israeli. Lets pray for them to be save and Allah help them to be a brave heroes to save their land and our religion, Islam. Allahuakhbar!
my next topic is a about diabetic retinopathy since now i'm at 3rd weeks of ophthalmology posting at HUKM. (posting mata)
Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina in the back of the eye. Its altered vascular permeability (loss of pericytes, breakdown of blood retinal membrane and thickening of basement membrane.
1) Nonproliferative diabetic retinopathy (NPDR)
- Most patients (95%) have NPDR.
- This is the earliest stage of retinopathy and it progresses slowly.
- The earliest signs of retinal damage arise from capillary wall breakdown, seen on the fundus exam as vessel microaneurysms.
- Injured capillaries can leak fluid into the retina and the aneurysms themselves can burst, forming “dot-and-blot hemorrhages.”
2) Advanced/Severely Nonproliferative diabetic retinopathy
- non proliferative findings +
*intraretinal microvascular anomalies (IRMA) in 1 or 4 retinal quadrants
-IRMA: dilated, leaky vessels within the retina
*cotton wool spots (nerve fiber layer infarct)
3) Proliferative Retinopathy
- With ongoing injury to the retinal vasculature, there eventually comes a time when the vessels occlude entirely, shutting down all blood supply to areas of the retina.
- In response, the ischemic retina sends out chemicals that stimulate growth of new vessels.
- This new vessel growth is called neovascularization, and is the defining characteristic of proliferative retinopathy.
- Far fewer patients have proliferative retinopathy, which is fortunate as this stage can advance rapidly with half of these patients going blind within five years if left untreated.
- What are the retinal signs of diabetic retinopathy. How do they compare to, say, hypertensive retinopathy.
-Hypertension usually has more flame hemorrhages and vascular changes such as arterial-venous nicking and copper/silver wiring.
- How are angiogenic molecules involved with diabetic retinas?
- What are some mechanisms in diabetic retinopathy that might lead to decreased vision? What causes the majority of vision loss in diabetic patients?
*Macular edema (probably the leading cause of vision loss)
- How do we treat advanced diabetic retinopathy?
- A 35 year old man with bad type-1 diabetes presents with a pressure of 65. His anterior chamber is deep but you find neovascularization everywhere - in the retina and on the iris. What do you think is causing the pressure rise, and how do you treat it?
-You treat neovascularization by PRP lasering the peripheral retina to decrease VEGF production.
- NVA (neovascularization of the angle) is hard to manage and this patient will probably require a surgical drainage procedure in the near future.
- Describe the three types of retinal detachment?
- What are the symptoms of a retinal tear or detachment?
- What is a PVD?
- An elderly patient presents with a brief episode of flashing and now has a single floater that moves with eye movement. A thorough retina exam reveals no detachment or tear, but you observe a small vitreous opacity floating over the optic disk. What has happened?
- What kind of surgeries can we perform to relieve retinal detachments?
- What is Schafer’s Sign?
- What kind of travel restrictions would you tell a patient who has a pneumatic retinopexy?
- What’s the difference between dry and wet age-related macular degeneration?
-Wet ARMD implies choroidal neovascularization that has grown up through Bruch’s membrane.
MeREpek story from CIk BELLA:
pesanan penaja: Jaga lah mata anda kerna mata adalah satu anugerah yang tak ternilai harganya. Bila da hilang fungsinya baru lah anda sedar betapa nikmatnya dapat melihat. Bagi mereka yang mempunyai masalah kencing manis sila lah control pemakanan anda supaya ianya tidak menimbulkan masalah pada mata pula. Amalkan gaya sihat dan banyak makan carrot untuk kesihatan mata.
Aligato and semoga mendapat ilmu yang bermanfaat.