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Posterior Segment > Block 15 Lectures 15-17 > Flashcards

Block 15 Lectures 15-17 Flashcards

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1
Q

Conditions in which mechanical forces distort the normal architecture of the macula are known as_____?

A

Tractional maculopathies

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2
Q

A fibrocellular membrane composed of a sheet of cells and fibrous tissue is called _______?

A

Epiretinal membrane

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3
Q

Which area of the retina is a epiretinal membrane usually located?

A

Overlying the macula

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4
Q

What is the cause of an epiretinal membrane with a relatively mild presentation?

A

Idiopathic

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5
Q

What type of cells typically make up an epiretinal membrane when the cause is idiopathic?

Where are those cells derived from?

A

Glial cells

Derived from posterior hyaloid

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6
Q

What age group are idiopathic epiretinal membranes more commonly seen in?

A

Older individuals, over 50

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7
Q

What causes metamorphopsia with an epiretinal membrane?

A

Thickening or contraction of membrane

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8
Q

When does an epiretinal membrane appear translucent/glistening and when does it appear opaque?

A

Translucent/glistening initially

Opaque as the membrane thickens

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9
Q

What are 2 effects that contraction of an epiretinal membrane can have on the appearance of the retina?

A
  1. Distorted retinal blood vessels

2. Wrinkling of underlying retina

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10
Q

How is a patient with a unilateral epiretinal membrane that has minimal macular involvement typically managed?

A

Monitored - can stay stable for years

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11
Q

If a patient has intolerable distortion in their vision due to an epiretinal membrane, how might they be managed?

A

Vitrectomy with membrane peeling

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12
Q

What is it called when the vitreous partially separates from the posterior pole, while remaining attached at the fovea?

A

Vitreomacular Traction Syndrome

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13
Q

An incomplete posterior vitreous detachment that is tugging on the fovea is called _____?

A

Vitreomacular Traction Syndrome

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14
Q

What are 2 common symptoms in a patient experiencing Viteromacular Traction Syndrome?

A
  1. Progressive blurring/distortion of vision

2. Flashes of light (“photopsia”)

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15
Q

How might the macula appear in Vitreomacular Traction Syndrome?

A

Wrinkled or distorted

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16
Q

How can the traction be released in severe or progressive cases of Vitreomacular Traction Syndrome?

A

Pars plana vitrectomy

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17
Q

What may be a cause/reason for age-related macular holes?

A

Tractional forces exerted by posterior hyaloid

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18
Q

Why are some patients with an age-related macular hole symptomatic until visiting an optometrist?

A

It is often not noticed until covering the better seeing eye

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19
Q

Describe the signs seen with an impending macular hole?

What stage is this?

A

Loss of foveal depression and split within retinal layers

Stage 1A

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20
Q

Describe the signs seen with an occult macular hole.

What stage is this?

A

Gap in photoreceptors without full-thickness hole

Stage 1B

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21
Q

Describe the signs seen with a small full-thickness hole.

What stage is this?

A

Crescent-shaped hole

Stage 2

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22
Q

Describe the signs seen with a full-size macular hole in stage 3

A

Full-size hole with adjacent traction

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23
Q

Describe the signs seen with a full-size macular hole in stage 4?

A

Full-size hole with complete PVD

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24
Q

If slit lamp biomicroscopy has inconclusive results, how can a definitive diagnosis of an age-related macular hole be made?

A

OCT

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25
What test can be used to differentiate between a true macular hole and a pseudohole?
Watzke Allen
26
What does the line look like in a Watzke Allen test if a true macular hole is present? A pseudohole?
Macular hole: Line is thinned or broken Pseudohole: Line is bent, but with uniform thickness
27
What procedure might be performed for a patient with an age-related macular hole in stage 2 and 20/50 vision?
Vitrectomy with peeling of internal-limiting membrane followed by gas tamponade for 3-7 days
28
Most patients with an age-related macular hole achieve vision equal to what VA following vitrectomy and peeling of internal-liming membrane?
20/40 or better
29
A small, easily overlooked gap amongst photoreceptors and/or subtle RPE defect is known as _____
Macular microhole
30
The accumulation of fluid in cyst-like intraretinal spaces within the perifoveal region is known as _____?
Cystoid macular edema
31
If fluid-filled microcystic spaces in cystoid macular edema coalesce into larger cavities, what could result?
Lamellar macular hole
32
Which retinal cell is probably abnormal in cystoid macular edema?
Muller cell
33
What subtle, initial change is seen on the fundus in cystoid macular edema?
Loss of foveal depression
34
What is the best way to see multiple cystoid areas in cystoid macular edema?
Red free light
35
A characteristic "petalloid" pattern is seen on fluorescein angiography in what condition?
Cystoid macular edema
36
What treatment could be used to decrease vascular permeability in cystoid macular edema?
Anti-VEGF
37
What is an idiopathic local serous detachment of the macula called?
Central Serous Chorioretinopathy
38
What type of patient is Central Serous Chorioretinopathy frequently seen in?
Young men with type A personality; healthy
39
What two ocular structures are most likely dysfunctional in Central Serous Chorioretinopathy?
1. Retinal RPE | 2. Choroidal choriocappilaris
40
What 2 locations can fluid accumulate in with Central Serous Chorioretinopathy?
1. Between neurosensory retina (photoreceptors) and RPE | 2. Beneath RPE
41
What are two systemic associations with Central Serous Chorioretinopathy?
1. Cushing's disease | 2. Systemic lupus erythematosus (SLE)
42
There is a strong association between Central Serous Chorioretinopathy and circulating levels of ____?
Endogenous or exogenous glucocorticoids
43
Increased permeability of choroidal blood vessels and defective RPE in Central Serous Chorioretinopathy is probably due to _____?
Chronically elevated glucocorticoid levels
44
What is a typical sign of Central Serous Chorioretinopathy?
Well-circumscribed round or oval serous elevation of retina, usually affecting macula. Perfectly normal optic nerve and remainder of macula. Unilateral...
45
Chronic Central Serous Chorioretinopathy is also known as _____?
Diffuse Retinal Pigment Epitheliopathy
46
Widespread distribution of small pigment epithelial detachments and extensive pigmentary changes with vision complaints that come and go is most likely _____?
Diffuse Retinal Pigment Epitheliopathy (Chronic CSCR)
47
What treatment option is most beneficial in cases of chronic Central Serous Chorioretinopathy?
Photodynamic therapy with Verteporfin
48
An idiopathic vascular disease characterized by terminal aneurysmal "polyp-like" endings of inner choroidal vessels is known as ____?
Polypoidal Choroidal Vasculopathy
49
Polypoidal Choroidal Vasculopathy is often mistaken for what 2 conditions?
1. Exudative AMD | 2. CSCR
50
Leaking "polyps" in Polypoidal Choroidal Vasculopathy cause recurrent _____?
Serous and/or hemorrhagic detachments of retina and RPE
51
Reddish-orange nodules visible near macula or disc along with a history of multiple recurrent pigment epithelial detachments or retinal detachments is most likely what condition?
Polypoidal Choroidal Vasculopathy
52
What test is usually required to confirm diagnosis of Polypoidal Choroidal Vasculopathy?
ICGA
53
What are 2 options for management of Polypoidal Vasculopathy?
1. Photodynamic therapy | 2. Laser of persistent/progressive lesions or feeder vessels, as long as not beneath fovea
54
Degenerative myopia usually involves an eye that is greater than _____ Diopters myopic and greater than ____ mm axial length?
6 Diopters | 26 mm
55
What could potentially cause legal blindness in degenerative myopia?
Secondary changes (not refractory)
56
What is the most common cause of vision loss in degenerative myopia?
Changes to macula
57
Breaks in Bruch's membrane are a common sign in Degenerative myopia and are referred to as ____?
Lacquer cracks
58
What type of retinal detachment is a degenerative myope prone to?
Rhegmatogenous RD
59
The presence of what sign in degenerative myopia may increase the risk for foveal retinoschisis or a macular hole?
Posterior staphyloma
60
If a patient with degenerative myopia develops Choroidal Neovascularization, how should this be managed?
Intravitreal anti-VEGF injections
61
What structure is abnormally brittle when Angioid Streaks occur?
Bruch's membrane
62
What part of the fundus are angioid streaks commonly found?
Encircling disc and radiating outward
63
What is the most common systemic association with Angioid streaks?
Pseudoxanthoma elasticum (PXE)
64
What bone disorder could be associated with Angioid streaks?
Paget disease
65
What activity should patients with angioid streaks avoid?
contact sports
66
Choroidal folds represent wrinkling of what three structures?
1. Inner choroid 2. Bruchs's membrane 3. RPE
67
If the appearance of choroidal folds lead to an incorrect diagnosis that involves wrinkling of the retina alone, what would that be called?
Epiretinal membrane
68
Alternating light/dark parallel bands arranged horizontally on an area of the retina correspond to _____ in Choroidal folds? (what is making them light/dark)
Adjacent areas of thin, stretched RPE and thick, compressed RPE
69
Are patients with choroidal folds often myopic or hyperopic?
hyperopic
70
How can you differentiate choroidal folds from retinal folds?
OCT and Fluorescein angiography
71
What causes impaired macular function in Hypotony Maculopathy?
Severely decreased intraocular pressure
72
What type of folds are often seen radiating out from the disc in hypotony maculopathy?
Chorioretinal folds
73
What type of folds are often seen radiating out from the fovea in hypotony maculopathy?
Retinal folds
74
What procedure "defines" hypotony maculopathy?
Tonometry
75
Chronic cases of hypotony maculopathy can lead to what?
Phthisis bulbs and loss of eye
76
How soon is blurred central vision often noticed within staring at the sun, causing solar maculopathy?
Within hours of exposure
77
How are the clinical findings of solar maculopathy described, both initially and weeks later?
Initially a sharply demarcated yellow/red foveal spot. | Spot fades over weeks and leaves foveal defect with pigmentary changes or lamellar hole.
78
How is solar maculopathy treated?
No treatment! Avoid staring at sun!

Posterior Segment (5 decks)

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