Flashcards in Retina Deck (154):
Choroidal melanoma risk factors
To find small ocular melanoma usinghelpful hints daily
Thickness > 2mm
Margin next to onh
3 Etdrs criteria for csme
1. Thickening wi 500 microns of fovea
2. Exudates wi 500 microns of fovea ass w thickening
3. Thickening of 1DD wi 1DD of fovea
What were the 2 main findings of the etdrs?
1. Asa does not effect progression of dr
2. Early rx of csme w focal laser decr vision loss by 50%
How does kenalog rx dme?
1. Inhibits release of vegf and tnf
2. Stabilizes endothelial tight jxns so theres less leakage
Name 3 types of high risk pdr (acc to the drs which looked at risk factors for va losa)
1. Nvd w vh
2. Nvd 1/3 dd wo vh
3. Nve 1/2 dd in size w vh
What did the diabetic vitrectomy study show?
Early (1-6 mo) rx of vh in type 1 dm is beneficial
What did the drcr.net show? (Diabetic retinopathy clinical research network)
A) @ 2 yrs focal laser worked better than both 1mg or 4 mg of kenalog for csme
B) laser +lucentis = laser + kenalog for DME
C) laser + lucentis better than laser alone
What causes vmt?
Incomplete pvd from macula
Separation of postrior hyaloid from ilm
What were the prp settings in the drs?
500 spot size
Whats the triad in lofgrens syndrome and who does is affect?
1. Hilar lymphadenop
2. Erythema nodosum
Type of sarcoid syndrome
Whats the triad of heerfordts syndrome
1. Parotid swelling
2. Cn7 palsy
Type of sarcoid syndrome
Monofocal subretinal lesion think cause is...
When there are multifocal subretinal lesions cause is likely
Bad thing associated with appmpe?
Whats another name for goldman-favre dz and what are the findings?
Enhanced s cone syndrome
2. No rod fxn
3. Too many blue cones
4. Not enough red and green cones
Whats another name for the bestrophin gene and what chromosome is it on?
Whats the eog and arden ratio in bests?
Arden ratio <1:5
Fa findings in crvo
Delayed av transit time >20 secs
Late staining of veins
Cap dropout if ischemic
Whats the tyndall effect?
Scattering of light through particles in a colloid (mix of oil in water)
what's the ellipsoid layer on OCT?
The IS/OS jxn (white line)
whats the max daily dose of plaquenil to prevent toxicity?
what % of pple w lattice will dev RD?
what % of pple w RD have lattice?
meridional fold- needs laser?
whats the wavelength of argon green?
Whats the ddx of pigmentary retinopathy and deafness?
Rubella vs ushers
Calcaflour white stain- for what?
which type of rp has the worst prognosis?
which type of rp has the best prognosis?
Whats the ERG pattern in CSNB?
negative ERG (B wave never comes up- it stays down)
what type of dystrophy is RP?
ROD-CONE (not the opposite- in these dystrophies the predominant cell loss is named first)
whats the VF defect in RP?
ring scotoma bc rods die first and they are in the periphery
whats the chance that a choroidal nevus will transform into a melanoma over 10 years?
what % of rp is sporadic?
whats the axon of the ganglions cells called?
what do the bipolar cells do?
they connect PR to upper layer axons
2 main causes of inflammation of retinal veins
whats RP inversus?
RP in which vision loss starts centrally
whats retinitis punctata albescens (RPA)
RP with post-equatorial white dots
what is the cause of hunters, hurlers, sanfillipo and schie syndromes?
elevated heparin sulfate (the dz start w "HS" and the cause starts w "HS")
What is the retina findings in hunters, hurlers, sanfillipo, scheie syndrome?
Whats kerns-sayre, whats the inheritance and what other eye prob is it ass with?
CPEO with pig retinopathy
A-V heart block
what causes deafness in ushers?
Defect in the organ of corti (its in the choclea- has been a board question before!)
whats the inheritance of ushers?
inherited chorioretinal dystrophies inheritance pattern is most commonly....
AR- if you don't know it guess AR
Bassen-Korszweig dz- inheritance, symptoms, how to rule-out, how to treat?
Decr vision (RP-like) 2/2 no vit A
serum protein electrophoresis
supplement w vit A,D,E,K
Whats refsums disease-inheritance, symptoms, eye finings why is it important? (bc its treatable!)
deficiency in phytanic acid
restrict phytanic acid (milk, meats, leafy greens)
LCA- inheritance, eye findings, symptoms, appearance of disc
RP variant that occurs in kids
poor vision since birth
Batten disease- inher, symptoms, eye findings,
Alstrom syndrome- inheritance pattern, systemic finding, eye finding
Bardet-Biedl- inher pattrn, systemic findings, eye findings
polydactyl, short, fat
RP s bone spicules
How is Laurence-moon different from Bardet Biedl?
same retinal findings plus choroidal atrophy and no syndactyly
how much vitamin A (PALMATATE!) do you give in RP?
need to check LFTs
What vitamin should pple w RP avoid?
vitamin E (bc inhibits absoption of vit A)
What are the fat soluble vitamins
choroidemia - inher pattern
x-linked, rod-cone dystrophy
why does cone-rod dystrophy have a bulls-eye appearance>
bc all the cones are concentrated in the macula!
whats the erg in fundus flavimaculatis?
normal erg early
abnormal erg late
gyrate atrophy- inher pattern, defect in which enzyme, looks like what type of dancer, how to treat
defet in ornithine aminotransferase
think of the whirling dervishes like white circles
appearance of the retina is "islands that grow together" scalloped border, myopia, psc
restrict arginine (proteins) and give B6
whats the inheritance of stargardts?
whats the gene for bests?
whats the visual prognosis in bests?
20/40 unless dev cnv
whats the arden ratio in bests?
whats retinitis punctata albescens? (RPA)
type of RP with white dots in post-equatorial zone
see waxy pallor of disc
fundus albipunctatis- inher pattern, a subtype of what dz, erg finding in light, erg finding in dark
subtype of CSNB w white dots everywhere
abnormal ERG in light
normal ERG after being in dark for a while
oguchi dz- inher pattern, subtype of what, symptom, pathognomonic sign
mizuo-nakamura phenomenon- normal appearance of fundus in dark, but upon flash of light fundus appears green
whats a fuchs spot in myopia (aka forster fuchs spot)
area of pigmentation within atrophy corresponding to break in bruchs- bad sign for dev of cnv
x-linked retinoschisis- wheres the splitting, whats the cause, what part of retina in involved most?
Fucked up muller cells- poor adhesion of retina to itself
macula effected most
whats the other name of goldmann favre disease?
enhanced s-cone syndrome
what are the findings in enhanced s cone syndrome?
increased sensitivity to blue light
lesions along the arcades
ERG markedly abnormal
whats the inheritance in FEVR?
Why do you get VH in X linked retinoschisis?
bc the thin split NFL have the retinal vessels in them and they can break and bleed
what causes cholesterolosis bulbi?
recurrent VH, trauma
crystals typically settle to the bottom
parent w unilat RB has a child w unilateral RB whats the chance the next kid will have unilat RB?
parent had RB OU, has kid w no RB whats the chance the next kid could have RB?
what type of scotoma is caused by schisis
whats the sign in sticklers
optically empty vitreous
whats SF6 in real words?
whats c3f8 in real words
how long does ozurdex last?
what did the DRS define?
it defined high risk PDR- ie whos likely to bleed nd determined that these pple need PRP!
a) any NVD w VH
b) NVD >1/3 DD
c) NVE >1/2 DD + VH
What did the DCCT show?
Intensive treatment of DM1 with insulin delays onset of retinopathy
WHAT IS THE UNIVERSAL FINDING IN ALL TISSUES IN THE EYE IN DIABETES?
BM THICKENING (VERY FIRST SIGN OF DM IN EYE)
What finding might you find in the angle in a pt who had a crvo a while ago?
how is ICG metabolized?
what substance is responsible for the fluorescence of the retina?
what % of pple will get a cataract s/p ppv wi 2 yrs
whats the definition of pathological myopia
whats the pathology in CSNB
PR are ok but connective/glial cells are sick therefore nrmal A wave but negative B wave
how does dusn present?
fry the worm
ocriplasmin works for vmt in what % of eyes?
whats the inheritance pattern of tritanopia?
whats the inher pattern of deuteranopia?
if there is papilledema in HTN retinopathy, what grade is it?
grade 4 (worst)
what drug need to avoid in SS?
Who gets macroanuerysms most? males or females?
why do we observe MA first?
b/c its on the arterial side of the circulation, may spontaneously thrombose
what dz is eales connected to?
Glaucoma (higher IOP presses on crossing)
what are the 5 stages of ROP?
1) demarcation line
2) demarcation line w elevation
3) popcorn/hotdogs (fibrovascular prolif)
4) Subtotal detachment a) extrafoveal b) foveal
5) Total RD
whats the definition of threshold disease (as est in the CRYO-ROP trial in 1988?
any 8 clock hours (or 5 contiguous clock hours) of stage 3 ROP in zones 1 or 2 with plus dz
how does erm cause binocular diplopa?
the Geneva study looked at ozurdex for cme in brvo and crvo vs. what?
what cells are attacked in MAR?
bipolar cells in inner nuclear layer
how do you treat toxocara?
steroids and it is self limited.
anti-helminthic agents don't work well
whats "very severe" NPDR according to the ETDRS?
Having >2 criteria from the 4-2-1 rule
whats the chance of severe npdr turning into pdr in 1 yr
whats the risk of very severe npdr turning into pdr at 1 year?
Does cystinosis cause decreased vision, and when do you see retinopathy w cystinosis
retinopathy only when the kidneys are effected
cystinosis does NOT effect vision
ddx for crystaline retinopathy
"Too Many Nits BE"
BMI is a risk factor for which type of vein occlusion?
According to the BVOS when should you do PRP
When theres neo
(NOT based on # of clock hrs of ischemia)
what constitutes the outer blood eye barrier?
Whats the gene for familial amyloidosis and how does it present in the vitreous
what is transpupillary thermotherapy used for?
flat choroidal melanomas
whats the excitation light wavelength, flourescein floureses at what wavelength and what color is the filter
(the newborn wakes up at 4:30, you get them at 530 and their poop is yellow-green)
are wyburn-mason retinal angiomatosis lesions hereditary? and where else can they be?
can have a-v malformations in the brain.
what has "leopard spot" pattern on FA?
BDUMP- paraneoplastic 2/2 lung/ovarian ca
uveal effusion syndrome (2/2 transient thickened sclera)
what does "fixed retinal folds" imply?
PDT works best on what type of neo?
what did MARINA look at?
lucentis vs pdt for MINIMALLY classic (ie occult) cnv
what did anChor look at?
lucentis vs pdt for CLASSIC cnv
which type of lens give a 1:1 mag of the retina?
what does monochromatism mean? Ie rod monochromatism?
that that PR type is the only one they have
ie rod monochromatism- only have rods
how is rod monochromatism inherited?
how is blue cone monochromatism inherited?
amd risk factors
in high myopes which muscle might slip causing strabismus?
lateral rectus- causing eso
azoor- who gets it? initial presentation uni vs bilateral? fundus appearance, any prodrome?
women 30s- unilateral; men- bilateral
initial presentation- photopsias and vit cell
gets bone spiculing later
marked depression on mfERG
SE of intravitreal aminoglycosides
CAR vs MAR- which cells effected?
CAR- cones AND rods
MAR- rods only
most common malignancy ass w CAR?
scc of lung
incontinentia pigmenti- inheritance, skin finding, retinal finding
X-linked dominant (therefore lethal in males)
retina similar to ROP
Whats another name for incontinentia pigmenti?
where are pohs lesions usually located?
Fabrys dz what enzyme is deficient?
alpha-galactosidase A (fabRAY "A")
Tay sachs enzyme deficient
hexosaminidase A (cherry red spot) (sacks of hey -hexamine-A)
gauchers dz enzyme deficient
white spots in retina
neimann pick enzyme deficieny
sphingomylinase (don't pick your nose with your sphinger) cherry red pot
What laser spot size increases risk for cnv?
small spot size
how many degrees of field does amsler test?
what did the cruise study show
crvo w cme rx w iva x 6 mo do better than sham
what are the risk factors for suprachoroidal heme?
Why is the erg the way it is in csnb?
Bc the dz effects bipolar cells and there is poor transmission to the inner retina therefore normal a but shitty b wave
What cells make up the outer nuclear layer?
Cell bodies of the pr
What cells make up the inner nuclear layer?
Bipolar and horizontal cella
What did the maritime themed studies look at?
Safety and efficacy of lucentis , esp as compared to pdt
yag increases your chance for RD by how much?
high myope s/p CE, at 7 years out, whats the % chance he dev rd?