Case 23: Flashes of Light

Question 1

Posterior vitreous detachments (PVDs) result from detachment of the _______ _____ of the vitreous from the retina

Answer 1

Posterior hyaloid

Question 2

___% of people over the age of 50 have a PVD

Answer 2

50

Question 3

Rhegmatogenous RDs are characterized by what 2 things?

Answer 3

Atrophic holes, retinal holes

Question 4

Non-rhegamtogenous RDs are characterzied by what 2 things?

Answer 4

Exudate, traction

Question 5

Photopsia in eyes w/ an acute posteior vitreous detachment is thought to result from traction on the retina at sites of _______ _____

Answer 5

Vitreoretinal adhesion

Question 6

PVDs more common in which gender?

Answer 6

Females

Question 7

Risk factors of PVD

Answer 7

diabetes mellitus, intraocular surgery, intraocular inflammation, vit heme, trauma

Question 8

MC cause of retinal tear?

Answer 8

PVDs & vitreous liquefaction

Question 9

RD

Answer 9

separation of sensory retina from underlying RPE

Question 10

Rhegmatogenous OD

Answer 10

result from retinal break

Question 11

Atrophic hole

Answer 11

Small, round, full-thickness defect caused by chronic atrophy of sensory retina (NOT vitreoretinal traction); assoc w/ low risk for a subsequent RD. Most often located in the temporal retina (superior> inf) often assoc w/ lattice degen

Question 12

Retinal tears

Answer 12

Caused by vitreous traction

Question 13

Flap tear

Answer 13

Result of uneven vitreous traction; the vitreous traction often persists after the retinal tear occurs (vitreous remains attached to the flap), leading to an increased risk of a subsequent RD compared to operculated tears

Question 14

Operculated tear

Answer 14

symmetric & the result of even vit traction, vit traction no longer persists after the tear, reducing the risk of subsequent RD

Question 15

Exudative RD

Answer 15

Accumulation of fluid underneath the sensory retna due to damage to the RPE

Question 16

MC cause of exudative RD

Answer 16

ARMD

Question 17

MC cause of tractional RD

Answer 17

Proliferative diabetic ret

Question 18

RRDs MC occur in which gender?

Answer 18

Male

Question 19

___% of eyes that develop RRD will have assoc lattice, however only ___% of eyes w/ lattice degen will develop a RRD

Answer 19

20-33, 1

Question 20

____% of pts w/ an acute symptomatic PVD will have a retinal break

Answer 20

10-15

Question 21

In FHx of RRD or previous occurrence of RRD: both eyes are eventually affected in ____% of cases

Answer 21

10

Question 22

____% of all RDs occur in myopic eyes

Answer 22

40

Question 23

Signs of chronic RRD

Answer 23

Linear pigment demarcation line (takes 3 mo or longer to develop), intraretinal cysts (after 1 year), fixed folds, and/or subretinal precipitates

Question 24

The quadrant location in which pt reports ______ is of no value in predicting the location of the primary retinal break; however, the quadrant location for _____ is often valid

Answer 24

photopsia, VF defect

Question 25

Classical migraine

Answer 25

preceded by a visual aura that develops over 5-20 min & lasts less than 60 min

Question 26

Tx of symptomatic lattice degen (flashes/floaters)

Answer 26

Prophylactic tx w/ cryopexy or laser photocoagulation

Question 27

2nd MC lesion assoc w/ RD

Answer 27

vitreoretinal tuft

Question 28

When do you treat symptomatic retinal tear?

Answer 28

Immediately

Question 29

Retinal break tx

Answer 29

Laser photocoagulation or crytherapy; these techniques create a strong adhesion between the retina & RPE so vitreous fluid entering the retinal break cannot spread & create an RD

Question 30

Tx macular-detached RDs ("mac off")

Answer 30

Usually result in a permanent reduction in vision; these RDs should be treated urgently (48-96 hours)

Question 31

Tx macular-threatening RDs ("mac on")

Answer 31

Tx IMMEDIATELY 24 hours

Question 32

pneumatic retionpexy

Answer 32

intravitreal gas bubble is injected to temporarily tamponade the retinal tissue against the RPE: prevents additional vitreous fluid from entering the tear & allows the RPE to pump excess subretinal fluid into the choroid -> laser photocoagulation or cryotherapy is then used to permanently seal the retinal break

Question 33

Pneumatic retinopexy is primarily used for ______ retinal breaks

Answer 33

Superior

Question 34

Scleral buckle

Answer 34

A flexible silicone strip is permanently sutured on or within the sclera in order to indent the sclera & relieve vitreoretinal traction associated w/ the retinal break

Question 35

SE of scleral buckle

Answer 35

induced myopia, pain, hemorrhage, infection, diplopia

Question 36

vitrectomy

Answer 36

removal of the vitreous allows release of vitreoretinal traction

Question 37

Common indications for a vitrectomy w/ retinal breaks (2)

Answer 37

1. inability to visualize the retinal break as a result of a cloudy vitreous 2. inability to close retinal breaks through standard techniques, typically as a result of a very large breaks, posterior breaks that include a macular hole, & severe vitreoretinal traction

Question 38

Post-operative complications of tx of RD

Answer 38

elevated IOP, cataracts, hemorrhage, infection, post-operative positioning complications

Question 39

Exudative RD secondary to ARMD or diabetic ret tx

Answer 39

anti-VEGF injection