FUNDOSCOPY

1. FUNDALCHANGES
IN PRE-ECLAMPSIA
MAJANURADHA M SAWANT

2. FUNDOSCOPY
IN PIH
RETINA
 Mirror to the cardiovascular system of the body
FUNDOSCOPY
 Visualization of hypertensive changes
PIH
 Retinal changes run parallel with the severity of
hypertension hence that of pre-eclampsia

3. PROCEDURE
ONE DROP
EVERY 10 MINUTES
THREE TIMES
FUNDOSCOPY
AFTER ONE HOUR
BEFORE FOUR HOURS

4. SYSTEMIC
HTN
 VASOSPASM
 VASOSCLEROSIS
 RETINOPATHY

5. NORMAL FUNDUS
 Uniform Caliber
 Smooth sinuous
course
 Branch at obtuse
angle

6. VASOSPASM
 NARROWING
 STRAIGHTENING
 ACUTEANGLED
BRANCHING
 A-V RATIO 1:3

7. VASOSCLEROSIS
SALU’S SIGN
Deflection in the course of the vein at the
Arterio-venous crossing

8. VASOSCLEROSIS
GUNN’S SIGN
Concealment of the vein
beneath the artery
at the Arterio-venous crossing

9. RETINOPATHY
 SOFT EXUDATES
 RETINAL HEMORRHAGES
 RETINAL EDEMA
 HARD EXUDATES
 RETINAL DETACHMENT

10. RETINOPATHY
 Occulsion of precapillary arteriole
 Capillary nonperfusion
 Localised axoplasmic stasis
 Compact yellowish white fluffy lesions
 Cotton wool spots
SOFT
EXUDATES

11. RETINOPATHY
 Fibrinoid necrosis in the vessel wall
 Located in the Nerve fibre layer of retina
 Bright red flamed shaped hemorrhage
FLAME SHAPED
HAEMORRGHAGES

12. RETINOPATHY
 Increased capillary Permeability
 Retinal edema
 Precipitation of lipids
 Discrete dense yellow lesions
 Macular star
HARD EXUDATES
MACULAR STAR

13. RETINAL
DETACHMENT
 Accumulation of Serous fluid
between
 Retinal pigment epithelium
and
 Neurosensory retina
LOCALISED RETINAL DETACHMENT

14. RETINAL
DETACHMENT
TOTAL BULLOUS DETACHMENT

15. OPTICDISCEDEMA
MALIGNANT
HYPERTENSIVE
RETINOPATHY

16. KEITH-
WAGENE
R-
BARKER
1939
FEATURES K-W-R GRADING SURVIVAL
Narrowing of the retinal arteries I EXCELLENT
A-V CHANGES
SALU’S SIGN AND GUNN’S SIGN
II GOOD
RETINOPATHY
SOFT EXUDATES
FLAME HAEMORRHAGES
HARD EXUDATES
RETINAL EDEMA/RETINALDetachment
III
POOR
DISC EDEMA IV VERY POOR

17. AMERICAN
OPHTHALMOLOGICAL
SOCEITY
K-W-R
GRADING
AOA
GRADING
FEATURES
O Normal fundus
I I
II
Focal Narrowing
Diffuse generalised narrowing
II
III III RETINOPATHY
SOFT EXUDATES/FLAME HAEMORRHAGES
RETINAL EDEMA/RETINAL DETACHMENT
IV IV DISC EDEMA

18. IMPLICATION
FEATURES PREGNANCY
NORMAL FUNDUS
CONTINUE
FOCAL NARROWING
DIFFUSE NARROWING
RETINOPATHY
SOFT EXUDATES
FLAME HAEMORRHAGES
HARD EXUDATES
RETINAL EDEMA/RD
TERMINATE
DISC EDEMA

19. FUNDOSCOPY IN PIH
CONTINUE
TERMINATE

20. PROGNOSIS

21. THANKYOU