Acquired Macular Disease Flashcards Preview

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Flashcards in Acquired Macular Disease Deck (41):

Age-related macular hole ( FTMH)

  1. Who are prone? Male or Female?
  2. Age?
  3. How do they present with?

  1. Usually female 
  2. In 60s or 70s 
  3.  Present with 
  • severe impairment of central vision 
  • asymptomatic deterioration, first noticed when the other eye is closed 



Age-related macular hole 

Pathogenesis ? What structures involved?

Photoreceptors are displaced due to centrifugal force, probably c/b abnormal attachment of the vitreous and fovea 

Traction occurs pulling anterior and posteriorly 


Age-related macular hole 


Causes several stages 

1. a. Impending 

b. Occult 



4.Greater than 400μm 


Macular hole

 stages Stage 1a - Impending 



Characterized by 

  • flattening of the umbo 
  • yellow foveolar spot 
  • loss of the foveolar reflex. 

Rarely seen clinically 

Usually detected in a patient with a FTMH in the other eye 


Macular hole – stages Stage 1b - Occult 

  1. Vision defect?
  2. What do you see around fovea?
  3. Will it resolve?


  1. Patient c/o mild decrease in VA or metamorphopsia 
  2. Yellow ring seen around the fovea 
  3. About 50% of stage 1 holes resolve following spontaneous separation of the vitreous and fovea 

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Macular hole – stages Stage 2 – Early FTMH 

Size of defect area?

How long does it take to progress from stage 1 to 2?

Defect area is less than 400μm in diameter 

Can take 1-2 weeks to several months to progress from stage 1 to 2 

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Macular hole – stages Stage 3 – Established FTMH 

Size of defect? Thickness?

Stage 3 – Established FTMH 

Full thickness defect more than 400μm in diameter 

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Macular hole – stages Stage 4 – Greater than 400μm

Size of defect?


Effect on VA? 

  • Round defect more than 400μm in diameter 
  • Yellowish deposits within the round defect 
  • VA eventually stabilises as the hole reaches its maximum size 

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Macular hole - diagnosis 

  1. Name of simple test diagnosing macular hole? ( Gross diagnosis) 
  2. Procedure
  3. How patients with macular hole report?

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  1. Watzke-Allen test 
  2. Projecting a narrow slit beam over the centre of the hole both vertically and horizontally 
  3. Patient with a macular hole will report that the beam is thinned or broken 
    Patients with a pseudohole or cyst see a beam of uniform thickness which is distorted or bent 



Macular hole - diagnosis 

What is the most useful diagnosis tool?


OCT is useful to diagnose and determine the stage of macular holes 

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Is FFA useful in diagnosis of Macular hole? Why?


Macular hole - diagnosis 


•Not so useful 

•Shows hyperfluorescence which looks similar to: 



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Central Serous Retinopathy (CSR) 

  1. Aka?
  2. Definition? 
  3. Pathogenesis? 
  4. Affect one or both eyes? 
  5. Nature of this condition?
  6. Who does it mainly affect? 
  7. Aggravated ( worsen)  by?



  1. AKA: central serous chorioretinopathy 
  2. Sporadic ( infrequent, periodic) disorder of outer blood-retina barrier 
  3. Sensory retina around the macula becomes detached 
  4. Usually affects one eye only 
  5. Self-limiting 
  6. Mainly affects young/middle-aged men with “type A personality” 
  7. Aggravated by 

–Emotional stress 





CSR - signs 



Round/oval detachment of sensory retina at the macula 

OCT shows elevation of the retinal layer from the RPE 

Separated by optically empty zone 

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CSR - course 

Short - Prolonged - Chronic 

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  1. Caused by?
  2. Any short term effect?
  3. If long standing, can cause what?
  4. Damange reversible?

  1. C/b accumulation of fluid in the outer plexiform and inner nuclear layers of the retina 
    Fluid-filled cysts form 
  2. No short-term effects 
  3. If long-standing, can lead to large cavities at the fovea
  4. Irreversible damage to central vision 

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CMO - presentation 

  1. Patient presentation depends on ?
  2. VA affected?
  3. Patient c/o?

  1. Patient presentation depends on aetiology 
  2. VA could be affected by a pre-existing condition which has caused the CMO 
  3. If no pre-existing disease: 
    patient c/o: 
  •  impaired central vision & 
  •  positive central scotoma 

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CMO – Slit-lamp signs ?



On slit-lamp examination you see: 

  • loss of the foveal depression 
  • thickening of the retina 
  • multiple cysts 

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CMO – OCT signs 




Hyporeflective spaces within the retina 

Overall macular thickening 

Loss of foveal depression 

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CMO – FFA signs

  1. Arteriovenous phase?
  2. Late phase?

  1. Arteriovenous phase: 
    Small hyperfluorescent spots 
    Caused by early leakage 
  2. Late phase: 
    'flower-petal' pattern of hyperfluorescence 
    Caused by accumulation of dye within cystic space

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CMO Causes 

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High myopia 

•What’s the definition of high myopia? 

6.00D or more 

Axial length greater than 26mm 

Excessive elongation- changes to everything 

Pathological myopia: elongating and stretching soccer ball into a football => Everything is afffected 


High Myopia
Pathological or degenerative myopia is characterized by ?

Secondary changes to which structures?

Pathological or degenerative myopia is characterized by: 

progressive and excessive anteroposterior elongation of the globe 

  • Associated with secondary changes involving the: sclera, retina, choroid and optic nerve head 



Degenerative myopia 

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Tigroid appearance ( Tiger-stripe shape) 

Brecks in Bruch's membrane 

Lacquer cracks 

Due to diffuse attenuation of RPE with visibility of large choroidal vessels 



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Degenerative Myopia 

Focal choroidal atrophy and titled disc 

Optic nerve more rounded/ovally 

white= sclera 

Black= retinal pigment 

Visibility of larger choroidal vessles and evetually sclera 



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Ruptures in RPE Brunch's membrane

Choriocapillaris complex 

Fine, irregular yellow line branching & corssing @ Posterior pole 

Lacquer crack ?



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Choroidal neovascularisation 


Lacquer cracks 



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Subretinal coin haemorrhage 



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Degenerative myopia 

Fuch's spot 


Degenerative myopia 

Any impact on visual acuity 

Impede on macula 

If out in periphery - not going to complain as much 

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Angioid streaks 

  1. What is it? 
  2. Cause?
  3. Apperance?
  4. Location?
  5. Pattern? in relation to disc?


Angioid streaks 

  1. Crack-like ruptures in Bruch’s membrane 
  2. Occurs as a result of thickened, calcified and abnormally brittle collagenous and elastic portion of Bruch membrane 
  3. Linear, grey/dark red lesions with irregular edges 
  4. Lie beneath normal retinal vessels 
  5. Communicate in a ring-like way around the disc and radiate outwards 

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Angioid streaks 

FFA sign? 

Cause by?


Angioid streaks 

•Hyperflurescence is seen on FFA 

•C/b window defects in the RPE 

•FFA is mostly used to detect CNV 


Angioid streaks 

Sign on fundus? 


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•Optic disc drusen are commonly found 

Choroidal rupture following minor ocular trauma causes subretinal haemorrhage 

–Eyes with angioid streaks are very fragile! 

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Solar retinopathy 

  1. What is it?
  2. Effect on VA? 

Solar retinopathy 

  1. Retinal injury caused by photochemical effects of solar radiation by directly or indirectly viewing the sun (eclipse retinopathy) 
  2. Patient presents within 1-4 hours of solar exposure with 

–unilateral or bilateral central VA ↓ 

–small central scotoma 


Solar retinopathy 

Sign on fundus?



Solar retinopathy 

  • Fundus shows 

Small yellow or red foveolar spot 

Fades within a few weeks 

Spot is replaced by a sharply defined foveolar defect with irregular borders or a lamellar hole 

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Phototoxic maculopathy 

Yellow spot on macula 

Burned a hole in both fovea

OCT below= resolve ! 

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Case study 

62 y/o female 

3/52 history of decreased VA 

VA RE = 6/18 




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Stage 1B macular hole 

Fundus shows cystic appearance at the fovea 

OCT shows elevation at the foveal level 

Remaining retina bridges over the fovea 

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Case study 

69 y/o female 

C/o decreased VA worse in the RE, for past few months 

VA RE = 6/60 


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Full thickness macular hole 

Full-thickness hole confirmed on OCT 

•Loss of retinal tissue at the fovea 

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Case study 

42 y/o male 

C/o progressive central vision loss RE over past 1/12 



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Central Serous Retinopathy 

Dilated fundus exam shows diminished foveal reflex 

FFA shows pinpoint leak inferior to the fovea 

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Patient with psuedo-phakic LE 

•VA LE = 6/9 

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Fundus exam shows drusen 

FFA shows late staining of the areas of drusen 

OCT shows altered foveal contour 

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45 y/o female 

Referred for evaluation central visual distortion in RE for 6/12 

VA RE = 6/7.5 


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Angioid Streaks

OCT shows normal neurosensory retina and normal foveal contour 

Choroid on the RHS shows irregularity 

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60 y/o female 

C/o decreased VA RE 1/12 post cataract Sx & IOL insertion 

VA RE = 6/30 


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