This is just a simple algorithmic method. Its not very accurate but simple enough to be used when assessing simple typical cases.
Almost 4 years of study, and I wasn't sure what I knew about DR. A 3 days program seemed to turn the tide (a lil).
Thank you to DOVS.
COMMITTEE MEMBERS OF DR WORKSHOP
Wow..simple algorithm..Good job n Credit to Zul.
ReplyDeleteAdmin
congrats zul... perhaps u would want to to edit some of the phrase to more scientific terms and of course exclude 'ada mata ' part and etc .... So, it would become more acceptable and publish it somewhere...
ReplyDeletezul- applause!! turn the tide?. uh, da pro nie
ReplyDeleteain- i agree with d scientific terms.. but as u can see it comes from zul, cut him some slack laa.. i'd say creatively simple or simply creative.. both would do la, hehe ^^
i'd like to share an experience during my ORC posting last wiks..
- this pt (57/M/M) came for follow up of cataract extraction
- has DM and HPT for years (not noted since when)- on medication 6/12
Fundus camera revealed
-2 cotton wool spots appearance at inferior and superior temporal
-no microaneurysm or exudates noticed
-macula looks completely fine
-but then i cant help but noticed an appearance of slight venous beading at inferior temporal quadrant..
i 'baca' this kondisi with Dr H till we came to a complete dx with Dr K..
based on innovative algorithm above with ur extra knowldge, wut stage would best describe this pt.. a snap yet i'd like to know ur verdicts ^^
since the pt had venous beading, we can classify the DR as severe NPDR
ReplyDeleteadmin
Salam.
ReplyDeletetq. tq all.
to ain:
sometimes its a lot easier to remember a 2-hr-humor than a 2 mins lecture. lgpn ni jes algorithm simple. x applicable utk sume case. bt can b a gud starting point 4 people yg b4 dis agk bebal psl DR. kalo publish somewhere, mesti ophthal, MO, AMO, staff nurse, @ jururawat masyarakat ckp "hek eleh budk undegrad nie... 2pn nk kecoh..."
to DD:
turn d tide - of course from bebal to iqbal. ataupn ko nk aku sbut from bebal to naufal?
bout d case... i thnk Br. Syah is right. lgpn, algorigthm ni jes utk simple typical cases. As Prof Adzrin said, most cases are atypical. ok la. lps niaku cube wat criteria-based nye assessment lk.
sekian, trimas.
may the peace be with you.
p/s to DD: aku nk 6 marks....
ok, so sir n zul said severe..
ReplyDeleteain would like to comment on this one too.. ill wait for her then.
zul:*beaming*
p/s to ZUL: take mine je.. xyah amek others.. i feel responsible for this.
I would say it is a moderate NPDR with no maculopathy.
ReplyDelete(hope that Ain will agree with my verdict)
Of course, it's not a mild one because there are cotton wool spots already.
Meanwhile, to say that it's severe, it has to fulfill at least one of these criteria:
1) 20 microaneurysms in each of 4 quadrants --> not observed in this case
2) venous beading in 2 or more quadrants --> in this case, there is only one venous beading, right?
3) IRMA in even only 1 quadrant --> not observed in this case
p/s 1: amboi dd... sejak workshop aritu, u memang sangat alert ngan venous beading kan~
p/s 2: I've never heard of "venous beading" before the workshop... huhu
ok so now we have 2 verdicts- severe n moderate..
ReplyDeletestill no reponse from ain.. ill wait till abes lunar new year celebration.. if ain still xjwb, i juz reveal, hehe..
@kak dilly: btul kak dil, venous beading +iRMA sumenye benda BARU bg i.. thanks to DR workshop ^^
haha... forgot bout this case already... miane..
ReplyDeletei could not help to agree with kak dil... since venous beading is only in one quadrant, the diagnosis could probably be moderate NPDR with no maculopathy...
however, this case seem a bit weird too me. patient has no microaneurysm , exudate or dot blot haemorrhge which are earlier sign of DR, instead he only got venous beading which is more severe...
since this patient also has hypertension, i start to wonder wether venous beading could also be a result from hypertension. Do u guys have any opinion?
tq ain for ur 'quick' response =P .. ur curiousity were same as mine during the 'baca' moment.. i wonder where are d earlier signs of DR..
ReplyDeletelikewise kak dil n ain, i came to 'moderate NPDR with no maculopathy'.. Dr H agreed with my dx but not Dr K..
since there is no earlier signs of DR traced from this pt's fundus- we can classify him as having 'MILD NPDR with no maculopathy'..
yes, venous beading is there yet it cannot be outweighed in contemplating dx to a higher degree of severity with absent of other earlier signs.. plus, only a mild one presents, thus pt can still be noted as having a mild stage..
as zul said d algorithm wont be applicable in all cases.. sometimes, logic plays a vital part in determining the dx..
tq all for ur participation.. it was good to refresh d memory ^^
From DR workshop, the specialist said that since there is beading, we classify it as severe. or maybe moderate-severe case.
ReplyDeletethis classification is very subjective . Thus, just follow your GURU. Saya berguru during DR workshop with the specialist(I cant remember her name). So, for me the answer is still mod-severe or severe NPDR.
-no microaneurysm or exudates (MA N EXUDATE are happened at OUTER PLEXIFORM LAYER
2 cotton wool spots appearance at inferior and superior temporal & Venous beading are happened at GCL and nerve fiber layer which are inner compared to OPL..Mana bisa kita diagnosisnya as a mild NPDR.
TQ.
Admin