Diabetic Retinopathy.

Signs

a-Mild non proliferative 

Dot and blot hemorrhages,microanurysms, and hard exudates, nearly always bilateral.

b-Moderate non proliferative 

Cotton-wool spots in one or two quadrants of the retina ,Note the presence of the cotton wool spot in the upper nasal quadrant made the diagnosis moderate .

In addition to the presence of moderate to sever capillary non perfusion showed by the  angiogram(p),plus findings in mild non proliferative .

c-Sever  non  proliferative

Cotton -wool spots in three or four quadrants of the retina ,Plus findings in moderate non proliferative .

d,e,f,g,h,i,j -Proliferative

Neovascularization within one disc diameter of or involving the optic disc 

( NVD)d,e, retina(NVE)f,g, or iris (NVI) ,fibrous tissue along the posterior surface of the  vitreous and adherent to the retina ( j ),retinal detachment , vitreous hemorrhage (d,h,i),

The findings in mild , moderate and sever non proliferative disease are sometimes present (note the capillary non perfusion  in (c) .usually bilateral . 

Clinically significant macular edema

1-Any retinal edema within 500Mm of the center of the fovea.

2-Hard exudates within 500Mm of the center of the fovea if associated with adjacent areas of retinal thickening.

3-Retinal edema more than 1 disc diameter of the center of the  fovea.

Treatment

In algorafi eye clinic we have the pan retinal photocoagulation strategy starting from the mild non proliferative diabetic retinopathy  and the V/A less than 6/18.(k)

Old laser scars (k,o)

k  argon laser

o  diode laser

New laser scars (i) argon laser

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Hypertensive Retinopathy.

Generalized or localized retinal arteriolar narrowing , almost always bilateral .

arteriovenous crossing changes, retinal arteriolar sclerosis, copper,or,silver wiring) , ghost vessels (i) ,cotton wool spots ,hard exudates often in a macular star ,configuration, flame-shaped hemorrhages, retinal edema ,arterial macroanurysms,retinal detachment,vitreous hemorrhage (g,k),central or branch occlusion of an artery or vein (j). 

Many confusion happened between the diabetic retinopathy and the hypertensive retinopathy or combined (h) and which one would be prominent, 

You would find the exudation more in the hypertensive retinopathy (a,b), or in the form of macular star (c,d,f) ,

Other wise the history would be important  value to diffrentiate hypertensive from diabetic,  

This is because laser photocoagulation does not help the hypertensive retinopathy and may lead to bleeding.

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Central Retinal Vein Occlusion 

(CRVO).

Painless loss of vision ,usually unilateral. 

Diffuse retinal hemorrhages in all quadrants of the retina;dilated tortuous retinal veins.

Cotton-wool spots ,disc Oedema and hemorrhages ;retinal  Oedema; Neovascularization of the optic disc or iris.

Types 

Ischemic  :  Multiple cotton wool spots usually more than 10, the angiogram demonestrated capillary non perfusion. (b) 

Non Ischemic : Mild fundus changes ,No cotton wool spots. (a)

Branch retinal vein occlusion

Ischemic   type (c,d) 

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Coats disease .

Congenital retinal telangiectasis,Leber's miliary aneurysms.

A retinal vascular abnormality  resulting in small multifocal outpouchings of the retinal vessels, associated with yellow intraretinal and subretinal exudate.An exudative retinal detachment may account of the leucocoria.It usually develops in males during the first two decades of life; rarely bilateral.

Note the sheathed and partly occluded retinal vessels in the area of active exudation) (a),

Submacular scar and yellowish intraretinal and subretinal exudates ,Note the excyclotorsion of this rt eye.

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  Branch retinal artery occlusion.

This  lady with 30 years old experienced sudden deterioration in her vision in the rt eye, although the occlusion is branch artery the visual acuity was counting finger, 

Note the superficial whitening of the retina superiorly , which means Ischemia of the retina.     b

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Sickle-Cell Disease.

Critical signs

Peripheral retinal Neovascularization in the shape of fan ( sea-fan ) sign (a) ,

Intraretinal hemorrhage 

( Salmon patch) ( b)

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 Rt. Fundus demonstrated Paramacular  and macular Telangiectasis ,Lipid exudates, Multiple macroanurysm, hemorrhage, sheathing and occluded retinal vessels in the area of active exudation.

Angiography showed evidence of Telangiectasis  and large peripheral zone of capillary non perfusion temporally.

Lt. Fundus demonstrated parafoveolar capillary Telangiectasis, no  dilated capillaries were visible.

Angiography revealed early leakage of dye from the retinal capillaries on the temporal side of the macula.

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Splinter hemorrhage associated with Glaucoma.

This male patient with 55 years old ,having  restricted visual field in his rt eye  due to the chronic simple glaucoma , The IOP was 26mmhg at the time of photographing, Note the splinter  hemorrhage ( big one ) inferior to the optic disc , We can call it small branch vein occlusion.