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Duke Elder 2020 > Vitreoretinal > Flashcards

Vitreoretinal Flashcards

1
Q

What is peripheral retinal degeneration?

A

abnormalities in the peripheral retina

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2
Q

What is lattice degeneration?

A

THINNING IN THE NEUROSENSORY RETINA

WITH OVERLYING VITREOUS LIQUEFACTION

VITREORETINAL ADHESIONS CHARACTERISED BY CIRCUMFERENTIAL ZIGZAG WHITE LINES WITH OVAL HOLES WITHIN THE LESION

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3
Q

What is the most important degeneration predisposing to retinal tears?

A

lattice degeneration

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4
Q

In what population is lattice degeneration most common?

A

6-10% of normal population and more common in myopic eyes

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5
Q

What % of people with rhegmatogenous retinal detachment have lattice degeneration?

A

30%

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6
Q

How is lattice degeneration managed?

A

PROPHYLACTIC TREATMENT ONLY IN PATIENTS WITH A RETINAL DETACHMENT IN THE CONTRALATERAL EYE,

IN THE FORM OF LASER RETINOPEXY

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7
Q

What is degenerative retinoschisis?

A

MICROCYTIC DEGENERATION RESULTING IN THE SPLITTING OF THE RETINAL LAYERS BETWEEN THE OUTER PLEXIFORM AND INNER NUCLEAR LAYERS, USUALLY INFEROTEMPORALLY

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8
Q

Describe the distribution of retinoschisis

A

mostly bilateral and symmeterical

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9
Q

In what type of eye is retinoschisis most common?

A

Hypermetropic,

not frequently associated with RRD

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10
Q

Describe the features of retinoschisis

A

SMOOTH CONVEX AND IMMOBILE ELEVATION OF RETINA WITH NO DEMARCATION LINE OF CHRONICITY WITH RRD

ASSOCIATED WITH ABSOLUTE FIELD DEFECT

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11
Q

What is posterior vitreous detachment?

A

SEPARATATION OF THE POSTERIOR VITREOUS CORTEX FROM THE NSR

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12
Q

What factors increase the likelihood of posterior vitreous detachment?

A

OCCURS WITH INCREASING AGE AS THE VITREOUS BECOMES MORE LIQUEFIED (SYNCHYSIS) WHICH RESULTS IN THE CREATION OF EMPTY POCKETS OF FLUID WITHIN THE VITREOUS, LEADING TO VITREOUS COLLAPSE

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13
Q

Describe the pathogenesis of posterior vitreous detachment

A

VITREOUS BECOMES MORE LIQUEFIED (SYNCHYSIS) WHICH RESULTS IN THE CREATION OF EMPTY POCKETS OF FLUID WITHIN THE VITREOUS, LEADING TO VITREOUS COLLAPSE

EVENTUALLY FLUID ESCAPES IN THE RETROVITREOUS SPACE SEPARATING THE POSTERIOR HYALOID FROM THE NSR

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14
Q

What are the features of posterior vitreous detachment?

A

PHOTOPSIA WITH ASSOCIATED FLOATERS, VA USUALLY UNAFFECTED

WEISS RING: THICKENED VITREOUS AVULSED FROM OPTIC DISC

SHAFER SIGN (PIGMENTED PARTICLES OR ‘TOBACCO DUST’ IN THE ANTERIOR VITREOUS) NEGATIVE

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15
Q

How is posterior vitreous detachment managed?

A

DOES NOT REQUIRE TREATMENT

WARN ABOUT RISK OF Rhegomatogenous RD AND ADVICE ON PRESENTING IMMEDIATELY IF SYMPTOMS WORSEN OR VISUAL FIELD IS AFFECTED

IF COMPLICATED WITH RETINAL TEAR, TREAT WITH LASER OR CRYORETINOPEXY

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16
Q

What are retinal breaks?

A

THESE ARE FULL-THICKNESS RETINAL DEFECTS, PROGRESSION TO RD IS RARE

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17
Q

Under what conditions can retinal breaks be treated?

A

High risk of RD:

  • HIGH MYOPIA > 6D
  • APHAKIA
  • GIANT RETINAL TEAR
  • SYMPTOMATIC U-SHAPED RETINAL TEAR
  • SYSTEMIC DISEASE
  • STICKLER SYNDROME
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18
Q

What is a retinal tear?

A

A U-SHAPED DEFECT DUE TO VITREORETINAL TRACTION ON A STRIP OF RETINA DUE TO posterior vitreous detachment

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19
Q

In what percentage of cases do retinal tears progress to RRD?

A

1/3

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20
Q

What can retinal breaks be associated with?

A

VITREORETINAL ADHESIONS SUCH AS AT THE MARGINS OF LATTICE DEGENERATION

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21
Q

What are the features of retinal breaks?

A

FLASHES

FLOATERS

WEISS RING

SHAFER SIGN POSITIVE

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22
Q

How are symptomatic retinal breaks treated?

A

laser retinopexy

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23
Q

What is a giant retinal tear?

A

A RETINAL TEAR EXTENDING >/ 3 CLOCK HOURS > 90 DEGREES

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24
Q

Where do giant retinal tears occur?

A

PERIPHERAL RETINA AT POSTERIOR BORDER VITREOUS

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25
Q

What are giant retinal tears associated with?

A

TRAUMA

HIGH MYOPIA

DISEASES E.G. MARFAN / STICKLER SYNDROME

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26
Q

how are giant retinal tears managed?

A

LASER RETINOPEXY FOR BOTH EYES

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27
Q

in what % of cases are giant retinal tears bilateral and in what % of cases are their retinal tears in the fellow eye?

A

16.5% and 60%

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28
Q

What is retinal dialysis?

A

A DISINSERTION OF THE RETINA AT THE ORA SERRATA INVOLVING ANTERIOR AND POSTERIOR TO THE VITREOUS BASES

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29
Q

What is the most common type of retinal dialysis and where does it occur?

A

TRAUMATIC RETINAL DIALYSIS IS MORE COMMON AND LOCATED SUPERONASALLY

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30
Q

Where does idiopathic retinal dialysis occur more commonly?

A

inferotemporally

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31
Q

What is the leading cause of traumatic retinal detachment in children and young adults?

A

Retinal dialysis

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32
Q

how is retinal dialysis managed?

A

LASER RETINOPEXY IF THERE IS NO ASSOCIATED RD, OTHERWISE SCLERAL BUCKLE IS USED

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33
Q

What is retinal detachment?

A

SEPARATION OF THE NSR FROM THE RPE

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34
Q

What is shifting sub-retinal fluid?

A

following detachment, SUBSEQUENT SHIFT OF SUB RETINAL FLUID IN THE SPACE BETWEEN THE NSR AND THE RPE

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35
Q

What are the three main types of retinal detachment?

A

RRD, TRACTIONAL RD AND EXUDATIVE RD

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36
Q

What is the most common form of retinal detachment?

A

RRD

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37
Q

Describe the pathogenesis of RRD

A

retinal break - FLUID SEEPS IN BETWEEN THE NSR AND RPE CAUSING A DETACHMENT

this is an emergency, can cause blindess

38
Q

What are the features of rhegmatogenous retinal detachment?

A

FLASHES AND FLOATER

CURTAIN-LIKE VISUAL FIELD LOSS (RELATIVE FIELD LOSS)

DVA IF MACULA IS INVOLVED

RAPD, WEISS RING AND SHAFER SIGN

PRESENCE OF PVD AND RETINAL BREAKS (COMMONLY A U-SHAPED RETINAL TEAR; MOST COMMON LOCATION IN SUPERTEMPORAL)

39
Q

Describe fresh RRD

A
  • CONVEX CORRUGATED DOME-SHAPED SURFACE WITH LOSS OF RPE MARKINGS
    SHAPE BASED ON MOST SUPERIOR RETINAL BREAK

EXTEND FROM ORA SERRATA TO OPTIC DISC

THEY ARE PROGRESSIVE AND MAY AFFECT MACULA

40
Q

Describe chronic RRD

A

RETINAL THINNING

DEMARCATION LINES

INTRARETINAL CYSTS

PROLIFERATIVE VITREORETINOPATHY

41
Q

What investigations are used for RRD?

A

SLIT LAMP BIOMICROSCOPY WITH WIDE-FIELD LENS

INDIRECT OPHTHALMOSCOPY WITH SCLERAL DEPRESSION TO VISUALISE THE ORA SERRATA

B-SCAN USS IS NO VIEW OF POSTERIOR POLE SUCH AS DENSE CATARACT OR VITREOUS HAEMORRHAGE

42
Q

What is the management for RRD?

A

VITRECTOMY: MOST COMMON PROCEDURE, INDICATED FOR POSTERIOR RETINAL BREAKS, GIANT RETINAL TEARS AND PROLIFERATIVE VITREORETINOPATHY

SCLERAL BUCKLE: VERY HIGH SUCCESS RATE, USED IN SIMPLE RRD AND RETINAL DIALYSIS WHEN THERE IS ANO PRE-EXISTING PVD

PNEUMATIC RETINOPEXY: LOWER SUCCESS RATE BUT ALSO FEWER SIDE EFFECTS; USED IN CAREFULLY SELECTED CASES WITH SMALL SUPERIOR BREAKS 1 CLOCK HOUR APART BETWEEN 11 AND 1 CLOCK HOURS

43
Q

What is tractional retinal detachment?

A

THIS IS DUE TO VITREORETINAL TRACTION

44
Q

describe the pathogenesis of tractional retinal detachment

A

INSIDIOUS PROCESS WHERE FIBROVASCULAR MEMBRANES CAUSE PROGRESSIVE CONTRACTURE OVER AREAS OF ADHESIONS EVENTUALLY CAUSING A DETACHMENT

45
Q

What are the most common causes of tractional retinal detachment?

A

ADVANCED PROLIFERATIVE DIABETIC RETINOPATHY AND ROP

46
Q

What are the features of tractional retinal detachment?

A

USUALLY ASYMPTOMATIC (NO FLASHES OR FLOATERS) AS THERE IS NO PVD

VA AFFECTED ONCE MACULA IS THREATENED CAUSING DISTORTION OF VISION

DETACHMENT: SHALLOW IMMOBILE CONCAVE TENTING OF RETINA

MINIMAL SHIFTING SRF

ASSOCIATED RELATIVE VISUAL FIELD LOSS, SIGNS OF UNDERLYING DISEASE

47
Q

What is the management of tractional retinal detachment?

A

VITRECTOMY WITH MEMBRANE PEEL

48
Q

What is exudative retinal detachment?

A

THIS RARE FORM OF RD OCCURS DUE TO BUILDUP OF SRF FROM DAMAGE TO THE OUTER BLOOD-RETINAL BARRIER

49
Q

Describe the pathogenesis of exudative retinal detachment

A

FLUID LEAKAGE OCCURS UNDER THE RETINA THEREBY SEPARATING THE NSR FROM THE RPE

OCCURS WHEN THE COMPENSATORY MECHANISMS OF THE RPE FAILED TO PUMP THE FLUID BACK INTO THE CHOROIDAL CIRCULATION

50
Q

What are some causes of exudative retinal detachment?

A

TUMOURS: CHOROIDAL TUMOURS

IDIOPATHIC: NANOPTHALMIA LEADING TO UVEAL EFFUSION SYNDROME

VASCULAR: EXUDATIVE AGE-RELATED MACULAR DEGENERATION, COATS’ DISEASE, CENTRAL SEROUS CHORIORETINOPATHY

51
Q

What are some inflammatory causes of exudative retinal detachment?

A

POSTERIOR UVEITIS: SYMPATHETIC OPTHALMIA AND Vogt-kayanadi-harada

POSTERIOR SCLERITIS, ORBITAL INFLAMMTORY DISEASE, POSTOP INFLAMMATION AND EXTENSIVE PAN RETINAL PHOTOCOAGULATION

52
Q

What are some features of exudative retinal detachment?

A

FLOATERS IF VITRITIS PRESENT, dVA IS AFFECTED

RD: SMOOTH CONVEX THAT IS SHALLOW OR BULLOUS, LACK OF PVD AND RETINAL TEARS AND EVIDENCE OF TRACTION

EVIDENCE OF UNDERLYING CONDITION

53
Q

How is exudative retinal detachment managed?

A

OPTHALMIC AND SYSTEMIC HISTORY AND EXAMINATION INCLUDING BLOOD PRESSURE AND URINALYSIS

TREATMENT OF UNDERLYING CAUSE TREATS THE RETINAL DETACHMENT; SURGERY NOT USUALLY INDICATED

54
Q

What is vitreous haemorrhage?

A

THIS IS BLEEDING INTO THE VITREOUS CHAMBER

MAY BE DUE TO TWO BASIC MECHANISMS; RUPTURE OF VESSELS THORUGH TRAUMA OR BLEEDING FROM PATHOLOGICAL PROCESSES

55
Q

What are some causes of vitreous haemorrhage?

A

TRAUMA :

  • BLUNT OR PENETRATING TRAUMA CAUSING CLOSED OR OPEN GLOBE INJURY
  • SHAKED BABY SYNDROME
  • ACUTE PVD ASSOCIATED WITH VITREOUS HAEMORRHAGE

NEOVASCULARISATION LEADING TO HAEMORRHAGE:

  • DIABETIC RETINOPATHY
  • SICKLE CELL RETINOPATHY

–ROP

  • WET ARMD
  • RETINAL VEIN OCCLUSION

OTHER: CHOROIDAL TUMOURS

56
Q

What investigations are used for vitreous haemorrhage?

A

ALL PATIENTS NEED A DETAILED FUNDAL EXAMINATION TO ASSESS THE SEVERITY OF HAEMORRHAGE AND EXCLUDE RETINAL TEARS

57
Q

What is the management for vitreous haemorrhage?

A

DEPENDENT ON CAUSE

PAN-RETINAL PHOTOCOAGULATION IF THERE IS A FUNDAL VIEW

INTRAVITREAL ANTI-VEGF IF THERE IS NO FUNDAL VIEW OR IN WET ARMD

PARS PLANA VITRECTOMY; OFTEN PRE-TREATED WITH INTRAVITREAL ANTI-VEGF FOR NON-CLEARING VITREOUS HAEMORRHAGE OR IN PRESENCE OF RETINAL DETACHMENT

58
Q

What is choroidal detachment?

A

A DETACHMENT OF THE CHOROID FROM THE SCLERA DUE TO THE ACCUMULATION OF FLUID OR BLOOD IN THE SUPRACHOROIDAL SPACE

59
Q

What are some causes of choroidal detachment?

A

ACUTE HYPOTONY (IOP<5mmHg), TYPICALLY FOLLOWING GLAUCOMA SURGERY

TRAUMA

60
Q

what are the features of choroidal detachment?

A

SMOOTH, DARK AND CONVEX ELEVATION ARISING FROM THE PERIPHERY

LARGE ‘KISSING’ CHOROIDAL DETACHMENTS CAN LEAD TO RD

61
Q

What is choroidal rupture?

A

A BREAK IN THE CHOROID MAY RESULT FROM CLOSED GLOBE INJURY DUE TO BLUNT TRAUMA

62
Q

Describe the features of choroidal rupture

A

THERE IS USUALLY DISRUPTION OF THE CHOROID, BRUCH MEMBRANE AND RPE; HOWEVER THE NEUROSENSORY RETINAL IS UNAFFECTED

ON EXAMINATION, A CRESCENT-SHAPED YELLOW SUBRETINAL STREAK IS SEEN USUALLY ADJACENT TO THE OPTIC DISC

63
Q

What is uveal effusion syndrome?

A

THIS IS A RARE AND BILATERAL ABNORMALITY OF THE CHOROID AND SCLERA

64
Q

In what population is uveal effusion syndrome most common in?

A

IT IS MOST COMMONLY SEEN IN MIDDLE-AGED HYPERMETROPIC MALES AND IS ACCOAITED WITH NANOPTHALMOS (AXIAL LENGTH <20mm)

65
Q

What are the features of uveal effusion syndrome?

A

MILD INFLAMMATION

THICKENED SCLERA

CILIOCHOROIDAL DETACHMENT

EXUDATIVE RD

RPE HYPERTROPHIC AREAS (LEOPARD SPOTS) IN CHRONIC CASES

66
Q

How is uveal effusion syndrome managed?

A

FULL-THICKNESS SCLEROTOMIES

67
Q

What is the epiretinal membrane?

A

THIS IS AN AVASCULAR FIBROCELLULAR SHEET OR MEMBRANE THAT DEVELOPS ON THE SURFACE OF THE RETINA

68
Q

Who is the epiretinal membrane more common in?

A

females

69
Q

What does the epiretinal membrane originate from?

A

PROLIFERATION OF RPE, GLIAL CELLS OR HYALOCYTES ON THE SURFACE OF THE RETINA

CONTRACTURE ON THE RETINA LEADS TO PROBLEMS SUCH AS ELEVATION OF THE RETINA AND CMO

70
Q

What are some synonyms for the appearance of the epiretinal membrane?

A

IN APPEARANCE: CELLOPHANE MACULOPATHY, MACULAR PUCKER

71
Q

What are some synonyms for the appearance of pathogenesis of the epiretinal membrane?

A

PREMACULAR FIBORSIS IDIOPATHIC PREMACULA GLIOSIS

72
Q

What are some causes of the epiretinal membrane?

A

IDIOPATHIC

TRAUMA

POSTERIOR UVEITIS

BRVO

IATROGENIC (CRYTHERAPHY, PHOTOCOAGULATION, RETINAL DETACHMEN SURGERY)

73
Q

What are some features of the epiretinal membrane?

A

ASYMPTOMATIC

METAMORPHOPSIA AND dVA

CELLOPHANE MEMBRANE: MAY BE TRANSPARENT BEST SEEN WITH RED-FREE LIGHT

MACULAR PUCKER: THICK CONTRACTED MEMBRANE WITH MILD DISTORTION OF BLOOD VESSELS

OTHER FINDINGS: MACULAR PSEUDOHOLE, CMO, RETINAL HAEMORRHAGES AND TELANGIECTASIA

74
Q

What investigations are used for epiretinal membrane?

A

OCT

75
Q

How is the epiretinal membrane managed?

A

OBSERVATION: ONLY IF CONDITION IS STABLE

VITRECTOMY

76
Q

What is a macular hole

A

A FULL THICKNESS DEFECT IN THE FOVEA WITH SPLITTING OF ALL NEUROSENSORY RETINAL LAYERS FROM THE INTERNAL LIMITING MEMBRANE TO THE RPE

77
Q

In what population is a macular hole most common?

A

FEMALES AGED 60-70

78
Q

What are some causes of the macular hole?

A

PRIMARY: VITREOUS TRACTION ON THE FOVEA FROM A PVD (VITREOMACULAR TRACTION)

SECONDARY: DOES NOT HAVE VITREOMACULAR TRACTION

E.G. CASES CAUSED BY TRAUMA OR HIGH MYOPIA

79
Q

What are some features of the macular hole?

A

METAMORPHOPSIA WITH CENTRA dVA

80
Q

How is the macular hole classified?

A

USED TO BE CLASSIFIED BY THE GASS CLASSIFICATION BUT THIS HAS BEEN REPLACED BY THE OCT CLASSIFICATION

81
Q

Describe the stages of classification for macular hole

A

VITREMACULAR ADHESION

VITREOMACULAR TRACTION

SMALL OR MEDIUM MACULAR HOLE WITH VMT

MEDIUM OR LARGE MACULAR HOLE WITH VMT

SMALL, MEDIUM OR LARGE MACULAR HOLE WITHOUT VMT

82
Q

How are macuular holes managed?

A

USUALLY PATIENTS ARE oBSERVED IN STAGE 1

STAGE 2 MACULAR HOLES CAN BE MANAGED WITH EITHER VITRECTOMY OR INTRAVITREAL VITREOLYSIS WITH OCRIPLASMIN

STAGES 3 AND 4 CAN BE MANAGED WITH VTRECTOMY, INTERNAL LIMITING MEMBRANE PEEL AND GAS TAMPONADE

83
Q

What are hereditary vitreoretinal degenerations?

A

THESE ARE RARE CONGENITAL CONDITIONS CHARACTERISED BY EARLY RETINAL AND VITREAL DEGENERATION

84
Q

What is x-linked retinoschisis?

A

DIFFERENT FROM DEGENERATIVE RETINOSCHISIS

DUE TO INTRACELLULAR ADHESION ABNORMALITIES WHICH LEAD TO SPLITTING OF THE RETINA AT THE NERVE FIBRE LAYER

85
Q

What are the features of x-linked retinoschisis?

A

TYPICALLY PRESENTES IN EARLY CHILDHOOD: HYPERMETROPIC BOYS PRESENT WITH READING DIFFICULTIES AT PRIMARY SCHOOL

ON EXAMINATION: BILATERAL MACULOPATHY, FOVEAL SCHISIS WITH SPOKE-LIKE FOLDS WITH CYSTOID CHANGES

RESEMBLING CMO WITHOUT LEAKAGE ON FA

86
Q

What investigations are used for x-linked retinoschisis?

A

SCOTOPIC ERG (-ERG):NORMAL a WAVE, LOSS OF b WAVE WITH OSCILLATORY POTENTIALS

87
Q

What is stickler syndrome?

A

MOST COMMON INHERITED CAUSE OF RD

CONDITION IS AD AND OCCURS DUE TO DEFECT IN COLLAGE SYNTHESIS

88
Q

Describe the features of stickler syndrome

A

OPTHALMIC: HIGH MYOPIA, CORTICAL CATARACTS, ECTOPIA LENTIS, GLAUCOMA, OPTICALLY EMPTY VITREOUS, RADIAL LATTICE-LIKE RETINAL DEGENERATION AND RRD

SENSORINEURAL DEAFNESS

PIERRE ROBIN FEATURES: MICROGNATHIA, GLOSSOPTOSIS, CLEFT PALATA, FLAT NASAL BRIDGE AND MAXILLARY HYPOPLASIA

MARFANOID FEATURES

89
Q

Describe the management of stickler syndrome

A

PROPHYLACTIC 360 RETINAL LASER

VITRECTOMY IF RD OCCURS

90
Q

What is wagner syndrome?

A

AD DISORDER SIMILAR TO STICKLER SYNDROME WITHOUT SYSTEMIC FEATURES

91
Q

What are the features of wagner syndrome?

A

LOW MYOPIA

CORTICAL CATARACTS

OPTICALLY EMPTY VITREOUS

92
Q

When is RD treated in wagner syndrome?

A

RD IS LINKED TO THIS CONDITION BUT IT LESS COMMON THAT IN STICKLER SYNDROME SO THEY ARE TREATED IF THEY OCCUR (I.E. NOT PROPHYLACTICALLY)

Duke Elder 2020 (9 decks)

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