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Choroidal melanoma risk factors
To find small ocular melanoma usinghelpful hints daily

Thickness > 2mm
Fluid (srf)
Symptoms
Orange pigment
Margin next to onh
Ultrasound Hollowness
Halo none
Drusen none

1

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

2

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%

3

How does kenalog rx dme?

1. Inhibits release of vegf and tnf
2. Stabilizes endothelial tight jxns so theres less leakage

4

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

5

What did the diabetic vitrectomy study show?

Early (1-6 mo) rx of vh in type 1 dm is beneficial

6

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

7

What causes vmt?

Incomplete pvd from macula

8

Whats synchesis?

Separation of postrior hyaloid from ilm

9

What were the prp settings in the drs?

500 spot size
0.1 sec
1200 burns

10

Whats the triad in lofgrens syndrome and who does is affect?

1. Hilar lymphadenop
2. Erythema nodosum
3. Iritis

Scandanavian women
Type of sarcoid syndrome

11

Whats the triad of heerfordts syndrome

1. Parotid swelling
2. Cn7 palsy
3. Iritis

Type of sarcoid syndrome

12

Monofocal subretinal lesion think cause is...

Infectious

13

When there are multifocal subretinal lesions cause is likely

Inflammatory

14

Bad thing associated with appmpe?

Cerebral vasculitis

15

Whats another name for goldman-favre dz and what are the findings?

Enhanced s cone syndrome
1. Cme
2. No rod fxn
3. Too many blue cones
4. Not enough red and green cones

16

Angiod streaks
Pepsi

Pagets
Ehlers danlos
Pseudoxanthoma elasticum
Sickle cell
Ideopathic

17

Whats another name for the bestrophin gene and what chromosome is it on?

Vmd2
Chrom 11

18

Whats the eog and arden ratio in bests?

Abnormal
Arden ratio <1:5

19

Fa findings in crvo

Delayed av transit time >20 secs
Late staining of veins
Cap dropout if ischemic

20

Whats the tyndall effect?

Scattering of light through particles in a colloid (mix of oil in water)

21

what's the ellipsoid layer on OCT?

The IS/OS jxn (white line)

22

whats the max daily dose of plaquenil to prevent toxicity?

6.5 mg/kg

23

what % of pple w lattice will dev RD?

1%

24

what % of pple w RD have lattice?

20-30%

25

meridional fold- needs laser?

yes

26

whats the wavelength of argon green?

510nm

27

Whats the ddx of pigmentary retinopathy and deafness?

Rubella vs ushers

28

Calcaflour white stain- for what?

Acanthomeba

29

which type of rp has the worst prognosis?

x-linked

30

which type of rp has the best prognosis?

AD

31

Whats the ERG pattern in CSNB?

negative ERG (B wave never comes up- it stays down)

32

what type of dystrophy is RP?

ROD-CONE (not the opposite- in these dystrophies the predominant cell loss is named first)

33

whats the VF defect in RP?

ring scotoma bc rods die first and they are in the periphery

34

whats the chance that a choroidal nevus will transform into a melanoma over 10 years?

50%

35

what % of rp is sporadic?

50%

36

whats the axon of the ganglions cells called?

the RNFL

37

what do the bipolar cells do?

they connect PR to upper layer axons

38

2 main causes of inflammation of retinal veins

sarcoid
eales dz

39

whats RP inversus?

RP in which vision loss starts centrally

40

whats retinitis punctata albescens (RPA)

RP with post-equatorial white dots

41

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")

42

What is the retina findings in hunters, hurlers, sanfillipo, scheie syndrome?

RP variants

43

Whats kerns-sayre, whats the inheritance and what other eye prob is it ass with?

CPEO with pig retinopathy
A-V heart block
CPEO
Mitochondrial

44

what causes deafness in ushers?

Defect in the organ of corti (its in the choclea- has been a board question before!)

45

whats the inheritance of ushers?

AR

46

inherited chorioretinal dystrophies inheritance pattern is most commonly....

AR- if you don't know it guess AR

47

Bassen-Korszweig dz- inheritance, symptoms, how to rule-out, how to treat?

AR
Decr vision (RP-like) 2/2 no vit A
serum protein electrophoresis
supplement w vit A,D,E,K

48

Whats refsums disease-inheritance, symptoms, eye finings why is it important? (bc its treatable!)

AR
ischthyosis,
deficiency in phytanic acid
RP changes
restrict phytanic acid (milk, meats, leafy greens)

49

LCA- inheritance, eye findings, symptoms, appearance of disc

AR
RP variant that occurs in kids
poor vision since birth
waxy pallor

50

Batten disease- inher, symptoms, eye findings,

AR
RP variant
MR, seizures

51

Alstrom syndrome- inheritance pattern, systemic finding, eye finding

AR
deafness
Rod-cone dystrophy

52

Bardet-Biedl- inher pattrn, systemic findings, eye findings

AR
polydactyl, short, fat
RP s bone spicules

53

How is Laurence-moon different from Bardet Biedl?

same retinal findings plus choroidal atrophy and no syndactyly

54

how much vitamin A (PALMATATE!) do you give in RP?

15,000 U/day
need to check LFTs

55

What vitamin should pple w RP avoid?

vitamin E (bc inhibits absoption of vit A)

56

What are the fat soluble vitamins

a,d,e,k

57

choroidemia - inher pattern

x-linked, rod-cone dystrophy

58

why does cone-rod dystrophy have a bulls-eye appearance>

bc all the cones are concentrated in the macula!

59

whats the erg in fundus flavimaculatis?

aka stargarts
normal erg early
abnormal erg late

60

gyrate atrophy- inher pattern, defect in which enzyme, looks like what type of dancer, how to treat

AR
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

61

whats the inheritance of stargardts?

AR

62

whats the gene for bests?

VMD2
chromosome 11
coding bestrophin

63

whats the visual prognosis in bests?

20/40 unless dev cnv

64

whats the arden ratio in bests?

abnormal
<1.5

65

whats retinitis punctata albescens? (RPA)

type of RP with white dots in post-equatorial zone
see waxy pallor of disc

66

fundus albipunctatis- inher pattern, a subtype of what dz, erg finding in light, erg finding in dark

AR
subtype of CSNB w white dots everywhere
severe nyctalopia
abnormal ERG in light
normal ERG after being in dark for a while

67

oguchi dz- inher pattern, subtype of what, symptom, pathognomonic sign

AR
CSNB
nyctalopia
mizuo-nakamura phenomenon- normal appearance of fundus in dark, but upon flash of light fundus appears green

68

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

69

x-linked retinoschisis- wheres the splitting, whats the cause, what part of retina in involved most?

RNFL
Fucked up muller cells- poor adhesion of retina to itself
macula effected most

70

whats the other name of goldmann favre disease?

enhanced s-cone syndrome

71

what are the findings in enhanced s cone syndrome?

nyctalopia
increased sensitivity to blue light
lesions along the arcades
ERG markedly abnormal

72

whats the inheritance in FEVR?

AD

73

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

74

what causes cholesterolosis bulbi?

recurrent VH, trauma
crystals typically settle to the bottom

75

parent w unilat RB has a child w unilateral RB whats the chance the next kid will have unilat RB?

30%

76

parent had RB OU, has kid w no RB whats the chance the next kid could have RB?

45%

77

what type of scotoma is caused by schisis

absolute

78

whats the sign in sticklers

optically empty vitreous

79

whats SF6 in real words?

sulfer hexaflouride

80

whats c3f8 in real words

perfluoro propane

81

how long does ozurdex last?

6 months

82

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

83

What did the DCCT show?

Intensive treatment of DM1 with insulin delays onset of retinopathy

84

WHAT IS THE UNIVERSAL FINDING IN ALL TISSUES IN THE EYE IN DIABETES?

BM THICKENING (VERY FIRST SIGN OF DM IN EYE)

85

What finding might you find in the angle in a pt who had a crvo a while ago?

PAS

86

how is ICG metabolized?

liver

87

what substance is responsible for the fluorescence of the retina?

lipofuscin

88

what % of pple will get a cataract s/p ppv wi 2 yrs

90%

89

whats the definition of pathological myopia

myopia >-8
AL >32.5

90

whats the pathology in CSNB

PR are ok but connective/glial cells are sick therefore nrmal A wave but negative B wave

91

how does dusn present?

neuroretinitis
choroiditis
mild vitritis
fry the worm

92

ocriplasmin works for vmt in what % of eyes?

25%

93

whats the inheritance pattern of tritanopia?

AD

94

whats the inher pattern of deuteranopia?

x-linked recessive

95

if there is papilledema in HTN retinopathy, what grade is it?

grade 4 (worst)

96

what drug need to avoid in SS?

CAI

97

Who gets macroanuerysms most? males or females?

females

98

why do we observe MA first?

b/c its on the arterial side of the circulation, may spontaneously thrombose

99

what dz is eales connected to?

TB

100

BRVO Risks

HTN
Atherosclerosis
Age >50
Glaucoma (higher IOP presses on crossing)

101

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

102

CRVO risks

******DM2******
HTN
Atherosclerosis
Glaucoma

103

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

104

how does erm cause binocular diplopa?

macular dragging

105

the Geneva study looked at ozurdex for cme in brvo and crvo vs. what?

sham injections

106

what cells are attacked in MAR?

bipolar cells in inner nuclear layer

107

how do you treat toxocara?

steroids and it is self limited.
anti-helminthic agents don't work well

108

whats "very severe" NPDR according to the ETDRS?

Having >2 criteria from the 4-2-1 rule

109

whats the chance of severe npdr turning into pdr in 1 yr

15%

110

whats the risk of very severe npdr turning into pdr at 1 year?

45%

111

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

112

ddx for crystaline retinopathy
"Too Many Nits BE"

Tamoxifen
Mellaril
Nitrofuratoin
Bietti
Etha;yne glycol

113

ganglioside GM2

tay-sachs

114

BMI is a risk factor for which type of vein occlusion?

BRVO

115

According to the BVOS when should you do PRP

When theres neo
(NOT based on # of clock hrs of ischemia)

116

what constitutes the outer blood eye barrier?

RPE

117

Whats the gene for familial amyloidosis and how does it present in the vitreous

transthiretin
vitreous opacities

118

what is transpupillary thermotherapy used for?

flat choroidal melanomas

119

whats the excitation light wavelength, flourescein floureses at what wavelength and what color is the filter

460-490 nm
520-530 nm
yellow-green
(the newborn wakes up at 4:30, you get them at 530 and their poop is yellow-green)

120

are wyburn-mason retinal angiomatosis lesions hereditary? and where else can they be?

sporadic
can have a-v malformations in the brain.

121

what has "leopard spot" pattern on FA?

BDUMP- paraneoplastic 2/2 lung/ovarian ca
or
uveal effusion syndrome (2/2 transient thickened sclera)

122

what does "fixed retinal folds" imply?

PVR

123

PDT works best on what type of neo?

type 2

124

what did MARINA look at?

lucentis vs pdt for MINIMALLY classic (ie occult) cnv

125

what did anChor look at?

lucentis vs pdt for CLASSIC cnv

126

which type of lens give a 1:1 mag of the retina?

super 66

128

what does monochromatism mean? Ie rod monochromatism?

that that PR type is the only one they have
ie rod monochromatism- only have rods

129

how is rod monochromatism inherited?

AR

130

how is blue cone monochromatism inherited?

x-linked recessive

131

amd risk factors

smoking
blue eyes
hyperopia
htn
hld

132

in high myopes which muscle might slip causing strabismus?

lateral rectus- causing eso

133

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
flu prodrome
vf defects

134

SE of intravitreal aminoglycosides

macular ischemia

135

CAR vs MAR- which cells effected?

CAR- cones AND rods
MAR- rods only

136

most common malignancy ass w CAR?

scc of lung

137

incontinentia pigmenti- inheritance, skin finding, retinal finding

X-linked dominant (therefore lethal in males)
skin bullae
retina similar to ROP

138

Whats another name for incontinentia pigmenti?

bloch-sulzberger syndrome

139

where are pohs lesions usually located?

mid-periphery

140

Fabrys dz what enzyme is deficient?

alpha-galactosidase A (fabRAY "A")

141

Tay sachs enzyme deficient

hexosaminidase A (cherry red spot) (sacks of hey -hexamine-A)

142

gauchers dz enzyme deficient

glucose cerebrosidase
white spots in retina

143

neimann pick enzyme deficieny

sphingomylinase (don't pick your nose with your sphinger) cherry red pot

144

What laser spot size increases risk for cnv?

small spot size

145

how many degrees of field does amsler test?

20 degrees

146

what did the cruise study show

crvo w cme rx w iva x 6 mo do better than sham

147

what are the risk factors for suprachoroidal heme?

old age
atherosclerosis
myopia
aphakia
HTN

148

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

149

What cells make up the outer nuclear layer?

Cell bodies of the pr

150

What cells make up the inner nuclear layer?

Bipolar and horizontal cella

151

What did the maritime themed studies look at?

Safety and efficacy of lucentis , esp as compared to pdt

152

yag increases your chance for RD by how much?

4x

153

high myope s/p CE, at 7 years out, whats the % chance he dev rd?

8%

154

bietti vs cystinosis

bietti- AR, decr ERG, corneal crystals
cystinosis- lysosymal storage disorder, occurs in cornea when it effects kidney, not visually significant