Block 15 Lectures 15-17 Flashcards Preview

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Flashcards in Block 15 Lectures 15-17 Deck (78):
1

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

Tractional maculopathies

2

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

Epiretinal membrane

3

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

Overlying the macula

4

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

Idiopathic

5

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

Where are those cells derived from?

Glial cells

Derived from posterior hyaloid

6

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

Older individuals, over 50

7

What causes metamorphopsia with an epiretinal membrane?

Thickening or contraction of membrane

8

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

Translucent/glistening initially
Opaque as the membrane thickens

9

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

1. Distorted retinal blood vessels
2. Wrinkling of underlying retina

10

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

Monitored - can stay stable for years

11

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

Vitrectomy with membrane peeling

12

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

Vitreomacular Traction Syndrome

13

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

Vitreomacular Traction Syndrome

14

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

1. Progressive blurring/distortion of vision
2. Flashes of light ("photopsia")

15

How might the macula appear in Vitreomacular Traction Syndrome?

Wrinkled or distorted

16

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

Pars plana vitrectomy

17

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

Tractional forces exerted by posterior hyaloid

18

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

It is often not noticed until covering the better seeing eye

19

Describe the signs seen with an impending macular hole?

What stage is this?

Loss of foveal depression and split within retinal layers

Stage 1A

20

Describe the signs seen with an occult macular hole.

What stage is this?

Gap in photoreceptors without full-thickness hole

Stage 1B

21

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

What stage is this?

Crescent-shaped hole

Stage 2

22

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

Full-size hole with adjacent traction

23

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

Full-size hole with complete PVD

24

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

OCT

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!