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Retina Flashcards

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0
Q

AMD Genetics

A

Complement factor H pathway.
HRTA1 gene T402H (5-fold increased risk of AMD) and 10q A69S (7-fold increase in risk for AMD) account for 75% of the genetic risk for AMD.

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1
Q

What is the ddx of a cotton wool spot

A
  • htn
  • dm
  • crvo/Brvo
  • retinal emboli (carotid or heart)
  • collagen vascular dz (sle, wegner, polyarteritis nodosa, scleroderma)
  • HIV
  • GCA
  • infections (toxoplasma, mucor, Lyme)
  • hypercoagulable state (lupus anticoagulant, homocysteinurea, protein c&s, at3 deficiency)
  • radiation retinopathy
  • interferon
  • purtscher and pseudo
  • cancer (metastatic carcinoma, leukemia, lymphoma)
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2
Q

Grades of hypertensive retinopathy

A 
0 - none
1- mild arteriolar narrowing
2 - obvious arteriolar narrowing, AV nicking
3 - grade 2 plus hmg and exudates
4 - grade 3 plus disc swelling
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3
Q

Hyperfluorescent lesions in AMD on IVFA

A 
Drusen (Hard and Soft) 
RPE Atrophy
RPE Tears
CNV
serous PED
Fibrovascular scarring
Laser scars
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4
Q

hypofluorescent lesions in AMD on FA

A

Lipid
Hemorrhage
Hypopigmentation

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5
Q

What is the differential of blood at multiple layers of the retina

A
  • valsalva
  • ruptured macroanneurysn
  • purtscher
  • terson’s
  • shaken baby
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6
Q

Patient has anaphylactic reaction to IVFA dye. What’s the dose of epi?

A

0.5 cc of 1:1000

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7
Q

AMD Masquerades

A 
Adult Vitelliform dystrophy (flattened dome,bilateral, no PE disruption)
Retinal pseudocysts in AR geographic atrophy - overlying area of  GA. 
Mac Tel (Type 2) - temporal predominance, bilteral, leakage occurs on FA but macular edema does no occur (leakage without thickening), progressive, early features include telangectasia (progressive), parafoveal greying, can get sub retinal NV and bleeding but this is not CNV. pigment clumping in temporal parafovea. Anti-VegF doesn't work. 
CSCR - thickened choroid and leakage, 1/2 dose vertopoforin. choroidal hyperpermiability of ICG, look for elongated outersegments in the serous RD, look for descending tract, Look outside the macula.
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8
Q

Definitions of Myopia

A

High Myopia -6.0 AL>26.5
Pathologic -8.0 AL>32.5
CNV develops in 5-10% of high myopes

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9
Q

Macular Star

A

Hypertension
Bartonella, syhpillis, lyme, TB
papilledema

Unusual but possible: CRVO and AION

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10
Q

CNV ddx

A

Hereditary:

  • AMD
  • Best
  • Stargardt

Degenerative:

  • pathologic myopia
  • angioid streaks
  • polypoidal

Infectious:

  • POHS
  • toxoplasmosis

Inflammatory:

  • MCP, PIC
  • Serpiginous
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11
Q

Crystalline retinopathy ddx

A

Disorders:

  • Bietti crystalline dystrophy
  • Cystinosis

Drugs (CEM TONT):

  • canthaxanthine (tanning agent)
  • ethylene glycol
  • methoxyflurane (anaesthesia)
  • tamoxifen
  • oxalic acid (degen product of methoxyflurane, or systemic disorder)
  • nitrofurantoin
  • talc
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12
Q

CWS ddx

A

Microvascular:

  • HTN, DM
  • radiation retinopathy

Vaso-occlusive

  • thrombo-embolic (heart, carotid)
  • GCA
  • hypercoagulable (protein C/S, anti-thrombin III, anti-phospholipid, anti-cardiolipin, factor V leidin)

Collagen vascular disease
- SLE, Wegener, RA

Infectious:

  • HIV, CMV
  • Toxoplasmosis, toxocara

Traumatic

  • Purtschers
  • pseudo-purtschers
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13
Q

Fundus manifestations of pathologic myopia

A
  • tigroid fundus
  • tilted disc
  • peripapillary atrophy
  • posterior staphyloma
  • lacquer cracks +/- CNV
  • intra-retinal hemorrhages
  • Foster Fuchs spots
  • lattice degeneration
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14
Q

DDx of NV

A
  • DM
  • OIS
  • BRVO, CRVO, CRAO
  • Sickle cell
  • ROP/FEVR/Incontinentia pigmenti
  • Eales dz
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15
Q

DDx of Bull’s Eye maculopathy

A

Chloroquine, hydroxychloroquine
AMD
Stargardts, fundus flavimaticus
Central areolar macular dystrophy

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16
Q

DDx of yellow spot at macula

A 
Best's
Old foveal hemorrhage
Solar retinopaty
Macular hole
Foveal drusen
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17
Q

Causes of retinal vasculitis

A

a

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18
Q

Diseases that give you teeth involvement

A

a

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19
Q

Carriers affected in which diseases

A

a

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20
Q

AMD definitions: subfoveal, juxtafoveal, extrafoveal

A

a

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21
Q

CME ddx

A

a

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22
Q

Choroidal folds ddx

A

a

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23
Q

Purtscher’s ddx

A

a

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24
Treatable RP's
a
25
CME that doesn't leak on FA
a
26
Choroidal mass
a
27
Serous macular RD
a
28
Types of Usher
a
29
Periphlebitis ddx
a
30
Fovea vs foveola (def'n)
a
31
Why do albinos have foveal hypoplasia
a
32
ERM ddx
a
33
EOG abnormal, ERG normal
a
34
Electronegative ERG
a
35
Salt and pepper retinopathy
a
36
Macular dragging
a
37
Frosted branch angiitis
a
38
Cherry red spot
a
39
Flecked retina
a
40
Straightened vessels around macula
a
41
What percentage of macula is rods vs cones?
a
42
What percentage of rods are in the macula?
a
43
Spontaneous vitreous hg
a
44
Foveal hypoplasia
a
45
Angioid streaks
a
46
Exudative RD
a
47
Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each
a
48
Conjunctival vascular anomalies
a
49
Subretinal peripheral black lesions
a
50
ROP mimickers
a
51
Retinal hemorrhage in infancy
a
52
Leopard spots on IVFA
a
53
Roth spots
a
54
ONH drusen ddx
a
55
ONH drusen - findings on exam
a
56
Retinal lipid
a
57
Bilateral macular scars in an infant
a
58
Bone spicule fundus
a
59
Parafoveal telangiectasias
a
60
CSR ddx
a
61
Usher's ddx (RP-like degen + hearing loss)
a
62
Nyctalopia ddx
a
63
Classic appearing macular toxo lesion
a
64
Indications to treat toxoplasmosis
a
65
Drugs to treat toxoplasmosis
a
66
Multifocal choroiditis
a
67
High risk PDR def'n
a
68
What did ETDRS teach us?
a
69
What did DRS teach us?
a
70
PRP complications
a
71
Severe NPDR?
a
72
What percentage of severe NPDR progress to PDR in 1 year?
a
73
Vit A deficiency causes
a
74
DDx of yellow spot at macula
``` Macular hole Best's Old foveal hemorrhage Solar retinopaty Foveal drusen ```
75
Causes of retinal vasculitis
Infectious - syphillis - toxoplasmosis - CMV - TB Inflammatory - Behcet - sarcoid - SLE
76
Diseases that give you teeth involvement
Peg teeth: - incontinentia pigmenti - syphillis Microdontia: - Axenfeld Reiger
77
Carriers affected in which diseases
Choroideremia Albinism X-linked RP
78
AMD definitions: subfoveal, juxtafoveal, extrafoveal
Subfoveal: under the fovea Juxta foveal: 1-199 um from fovea Extra foveal: >200 um from fovea
79
CME ddx
DEPRIVEN - DM - epinephrine - pars planitis - RP - idiopathic/inflammatory/Irvine Gass - vein occlusions (CRVO, BRVO) - prostaglandin E2 (e.g. xalatan) - nicotinic acid Others: - JXLR, Goldman Favre
80
Choroidal folds ddx
THIN RPE - choroidal tumors - hypotony - inflammation - NV (CNV) - retro-bulbar mass - pars planitis - extra-ocular hardware
81
Purtscher's ddx
DEFLATE - d - emboli of: - fluid, fat - l - amniotic fluid emboli - trauma - e
82
Treatable RP's
- abetalipoproteinemia (vit A & E) - refsum's disease (restrict fat) - gyrate atrophy (restrict arginine) - vit A deficiency
83
CME that doesn't leak on FA
- JXLR - nicotinic acid - some RP's
84
Choroidal mass
Nevus/melanoma Adenoma/adenocytoma CHRPE Lymphoma Mets Granuloma (toxocara) CNV, CSR
85
Serous macular RD
``` CSR VKH, SO Optic nerve pit CHRRPE RRD tracking to macula ```
86
Types of Usher
I - younger onset, more severe hearing loss | II - older onset, variable hearing loss
87
Periphlebitis ddx
a
88
Fovea vs foveola (sizes)
``` Fovea = 1.5 mm diam Foveola = 350 um diam ```
89
Why do albinos have foveal hypoplasia
Melanin is needed for retinal maturation
90
ERM ddx
VIT - vein occlusions - idiopathic, inflammatory - trauma, tears
91
EOG abnormal, ERG normal
- Best's - Pattern dystrophy - chloroquine, hydroxychloroquine
92
Electronegative ERG
2M, 3C, X/Q - myotonic dystrophy - MAR - CRVO - CRAO, - CSNB - JXLR - quinine toxicity
93
Salt and pepper retinopathy
- RP and all the different types - RP carrier - rubella
94
Macular dragging
- ROP - FEVR - toxocara
95
Frosted branch angiitis
- CMV | - sarcoid, syphillis, TB
96
Cherry red spot
- macular hemorrhage - CRAO (don't forget GCA) - macular edema - macular hole? - Tay Sachs - Neimann pick - Sanders - Gaucher
97
Yellow flecks in the retina
More macular: - AMD - Stargardt - Fundus flavimaticus More peripheral: - familial drusen - retinitis punctata albescens - fundus albipunctatus/CSNB/Oguchi dz
98
Straightened vessels around macula
- Macular telangiectasia - Coats - ERM
99
What percentage of macula is rods vs cones?
50% rods, 50% cones in the macula
100
What percentage of rods are in the macula?
5% of all rods are in the macula
101
Spontaneous vitreous hg
- Sickle cell - Trauma - Valsalva - Purtscher's - Retinal artery macroanneurysm - Terson's - Shaken baby
102
Foveal hypoplasia
- Albinism - craniosynostoses? - Aniridia
103
Angioid streaks
PEPSI - PXE - Ehler's danlos - Paget's disease of bone - Sickle cell (& thalassemia) - Idiopathic
104
Exudative RD
- CSR - Coats - CNV from any cause - Macular telangiectasia (IJT) - DM
105
Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each
Gene; prevalence; risk of retinopathy SC; 0.5%; 13% SThal; ____ ; AS; ___; 2% SS; 8%; 0.5%
106
Conjunctival vascular anomalies
Ataxia telangiectasia Sentinel vessels to underlying uveal melanoma CCF SWS Ocular dermal melanocytosis (nevus of Ota) Episcleritis, Scleritis
107
Subretinal peripheral black lesions
``` CHRPE Laser scars Nevus Melanoma Sicke cell (black sunburst) ```
108
ROP mimickers
FEVR | Incontinentia pigmenti
109
Retinal hemorrhage in infancy
Shaken baby, shaken baby, shaken baby Birth trauma Bleeding diathesis Leukemia
110
Leopard spots on IVFA
Sarcoid Mets Lymphoma
111
Roth spots
Leukemia, lymphoma HIV Septicemia Bacterial endocarditis
112
ONH drusen ddx
Autosomal dominant | Pseudoxanthoma elasticum
113
ONH drusen - findings on exam
``` Raised masses at disc margins; may look lumpy Bilateral but assymetric No obscuration of retinal vessels Visual field defects: enlarged blind spot, arcuate defects, temporal VF defects, etc (pretty much anything) Autofluorescent on FAF Hyperrefractile on CT Highly reflective on B-scan Negative 30-degree test on B-scan ```
114
Retinal lipid
DM | Coats
115
Bilateral macular scars in an infant
Toxoplasmosis | CMV
116
Parafoveal telangiectasias
NVD/NVE IJT (macular telangiectasia) Wyburn Mason
117
CSR ddx
``` VKH/SO CNV from any cause Optic nerve pit Choroidal mass causing exudation Hypotony with serous maculopathy ```
118
Usher's ddx (RP-like degen + hearing loss)
Refsum's | ??
119
Nyctalopia ddx
RP or any variant CSNB, Oguchi disease Vitamin A deficiency PRP
120
Classic appearing macular toxo lesion
Toxoplasmosis POHS ??
121
Indications to treat toxoplasmosis
- symptomatic decrease in vision - mod-severe vitritis - lesions threatening macula or optic nerve - acquired infections in pregnancy - congenital infections
122
Drugs to treat toxoplasmosis
- pyrimethamine - sulfadiazine - folinic acid +/- steroids clindamycin, azithromycin bactrim sporomycin in pregnancy
123
Multifocal choroiditis
``` POHS MCP, PIC Birdshot CHRPE from Gardner's syndrome Mets? Syphillis, TB ```
124
High risk PDR def'n
1. NVD > 1/4 - 1/3 DD 2. any NVD with VH 3. NVE > 1/2 DD with VH
125
What did ETDRS teach us?
E is for Edema - definition of CSME (usual 3) and when to treat Also told us that ASA is not helpful for DR
126
What did DRS teach us?
D is round like where we attack with PRP - told us that PRP is helpful for high-risk PDR - and maybe consider it for severe NPDR too
127
PRP complications
- constricted field - nyctalopia - misplaced burns (ie to macula) - increased macular edema - choroidal effusions that can cause ACG - decreased accomodation (long posterior ciliary nerves) - mydriasis - deep burns can lead to CNV
128
Severe NPDR?
``` 421 rule Any one of: - 4 quadrants of hemorrhages - 2 quadrants of venous beading - 1 quadrant of IRMA ```
129
What percentage of severe NPDR progress to PDR in 1 year?
15%
130
Vit A deficiency causes
``` Abetalipoproteinemia Short gut Poor diet Chronic diarrhea Inflammatory bowel disease ```
131
CNV ddx
Hereditary: - AMD - Best - Stargardt Degenerative: - pathologic myopia - angioid streaks - polypoidal Infectious: - POHS - toxoplasmosis Inflammatory: - MCP, PIC - Serpiginous Traumatic: - choroidal rupture - intense laser scars, cryo injury - surgical trauma
132
Crystalline retinopathy ddx
Disorders: - Bietti crystalline dystrophy - Cystinosis - gyrate atrophy Drugs (CEM TONT): - canthaxanthine (tanning agent) - ethylene glycol - methoxyflurane (anaesthesia) - tamoxifen - oxalic acid (degen product of methoxyflurane, or systemic disorder) - nitrofurantoin - talc
133
CWS ddx
Microvascular: - HTN, DM - radiation retinopathy Vaso-occlusive - crvo/brvo - thrombo-embolic (heart, carotid) - GCA - hypercoagulable (protein C/S, anti-thrombin III, anti-phospholipid, anti-cardiolipin, factor V leidin, homocystinuria) - leukemia, lymphoma Collagen vascular disease - SLE, Wegener, pan Infectious: - HIV, CMV - Toxoplasmosis, lyme Traumatic - Purtschers - pseudo-purtschers
134
Fundus manifestations of pathologic myopia
- tigroid fundus - tilted disc - peripapillary atrophy - posterior staphyloma - lacquer cracks +/- CNV - intra-retinal hemorrhages - Foster Fuchs spots - cystoid, paving stone, or lattice degeneration
135
DDx of NVE
- DM - OIS - BRVO, CRVO, CRAO - Sickle cell - CCF - ROP/FEVR/Incontinentia pigmenti - Eales dz - vasculitis (sarcoid, SLE, uveitis, etc)
136
DDx of Bull's Eye maculopathy
``` Chloroquine, hydroxychloroquine AMD Stargardts Central areolar macular dystrophy Cone, cone-rod dystrophies Pattern dystrophy Chronic macular hole ```
137
DDx of yellow spot at macula
``` Macular hole Best's Adult vitelliform dystrophy Old foveal hemorrhage Solar retinopaty Foveal drusen Pattern dystrophy CSR, CME ```
138
Causes of retinal vasculitis
Infectious - syphillis - toxoplasmosis - CMV - TB - ARN - Bartonella Inflammatory - Behcet - sarcoid - SLE - Birdshot - pars planitis (MS) - Eales Rifabutin
139
Diseases that give you teeth involvement
Peg teeth: - incontinentia pigmenti (Bloch-Sulzberger) - syphillis Microdontia: - Axenfeld Reiger
140
Posterior manifestations of sarcoid
- Vitritis - Snowbanking - candle wax dripping - multifocal choroiditis - optic nerve swelling - posterior scleritis
141
AMD definitions: subfoveal, juxtafoveal, extrafoveal
Subfoveal: under the FAZ Juxta foveal: 1-199 um from fovea Extra foveal: >200 um from fovea
142
CME ddx
DEPRIVEN - DM - epinephrine - pars planitis - RP - idiopathic/inflammatory/Irvine Gass - vein occlusions (CRVO, BRVO) - prostaglandin E2 (e.g. xalatan) - nicotinic acid Others: - JXLR, Goldman Favre - ERM
143
Choroidal folds ddx
THIN RPE - choroidal tumors - hypotony - inflammation - NV (CNV) - retro-bulbar mass - posterior scleritis - extra-ocular hardware
144
Purtscher's ddx
DEFLAT-P - dermatomyositis - emboli of: - fluid, fat - lupus, leukemia - amniotic fluid emboli - trauma - pancreatitis
145
Treatable RP's
- abetalipoproteinemia (vit A & E) - refsum's disease (restrict fat) - gyrate atrophy (restrict arginine) - vit A deficiency - DUSN (unilateral)
146
CME that doesn't leak on FA
- JXLR, Goldman Favre - nicotinic acid - Leber's stellate neuroretinitis - some RP's - LHON: disc doesn't leak even though it looks inflamed
147
Choroidal mass
Pigmented: - Nevus/melanoma - Adenoma/adenocytoma - CHRPE Non-pigmented: - amelanotic melanoma - choroidal osteoma Lymphoma Mets Granuloma (toxocara) CNV, CSR
148
Serous macular RD
``` CSR VKH, SO Optic nerve pit Uveal effusions CHRRPE RRD tracking to macula CNV ```
149
Types of Usher
I - younger onset (1st-2nd decade), profound deafness | II - older onset (2nd-4th decade), partial deafness
150
Fovea vs foveola (sizes)
``` Fovea = 1.5 mm diam Foveola = 350 um diam (FAZ) ```
151
Why do albinos have foveal hypoplasia
Melanin is needed for retinal development @ 6 weeks GA
152
ERM ddx
VIT - vein occlusions - idiopathic, inflammatory - trauma, tears
153
EOG abnormal, ERG normal
- Best's - Pattern dystrophy - chloroquine, hydroxychloroquine
154
Electronegative ERG
2M, 3C, X/Q - myotonic dystrophy - MAR - CRVO - CRAO - CSNB - JXLR - quinine toxicity
155
Salt and pepper retinopathy
- RP and all the different types - carriers (RP, choroideremia, albinism) - rubella, syphillis, varicella
156
Macular dragging
- ROP - FEVR - incontinentia pigmenti - toxocara
157
Frosted branch angiitis
- CMV - leukemia, lymphoma - TB
158
Cherry red spot
- CRAO (don't forget GCA) - macular commotio - macular hole - macular hemorrhage - Tay Sachs - Neimann pick - Sandhoff - Gaucher
159
Straightened vessels around macula
- Macular telangiectasia - ERM - ROP, FEVR, IP, toxocara
160
What is the histological definition of the macula
2 layers of GCL
161
What are the layers of the retina
``` ILM NFL GCL IPL INL OPL ONL ELM PR's RPE Bruch's ```
162
What's special about the OPL?
- watershed zone between inner and outer circulation - CME happens in OPL - called Henle's layer in the macula - polarisation responsible for Haidinger Brush phenomenon
163
Spontaneous vitreous hg
- PDR #1 - other causes of retinal NV (BRVO, CRVO, CRAO, OIS) - Retinal break/ hemorrhagic PVD - Sickle cell - Trauma - Valsalva - Purtscher's - Retinal artery macroanneurysm - Terson's Kids: - Shaken baby, birth trauma - JXLR (#1 in young boys)
164
Foveal hypoplasia
- Albinism | - Aniridia
165
Exudative RD
- CSR - Coats - CNV from any cause - Macular telangiectasia (IJT) - DM - VHL - idiopathic uveal effusions
166
Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each
Gene; prevalence; risk of retinopathy SC; 0.5%; 33% SThal; ____ ; 14% SS; ___; 3% SA; 8%; rare
167
Conjunctival vascular anomalies
Ataxia telangiectasia Sentinel vessels to underlying uveal melanoma CCF SWS Ocular dermal melanocytosis (nevus of Ota) Episcleritis, Scleritis
168
ROP mimickers
FEVR Incontinentia pigmenti Sickle cell
169
Retinal hemorrhage in infancy
``` Shaken baby, shaken baby, shaken baby Birth trauma Bleeding diathesis Leukemia CPR ```
170
Leopard spots on IVFA
Mets Lymphoma, leukemia Uveal effusion syndrome BDUMP
171
Roth spots
``` Leukemia, lymphoma HIV Septicemia Bacterial endocarditis Shaken baby, birth trauma ```
172
Retinal lipid
``` DM, radiation Coats HTN Papilledema Macular star VHL ```
173
CSR ddx
``` VKH/SO CNV from any cause Optic nerve pit Choroidal mass causing exudation Hypotony with serous maculopathy Peripheral RD that tracks to centre AMD Polypoidal ```
174
Usher's ddx (RP-like degen + hearing loss)
``` Refsum's Congenital rubella congenital syphillis Eales X-linked albinism can have hearing loss ```
175
Nyctalopia ddx
RP or any variant (incl Lebers congenital amaurosis) CSNB, Oguchi disease Vitamin A deficiency PRP
176
Classic appearing macular toxo lesion
``` Toxoplasmosis POHS Serpiginous Sarcoid Endophthalmitis ```
177
Multifocal choroiditis
``` POHS MCP, PIC, Birdshot, MEWDS CHRPE from Gardner's syndrome Mets? Syphillis, TB, lyme ```
178
What did ETDRS teach us?
E is for Edema - definition of CSME Also told us that ASA is not helpful for DR
179
Vit A deficiency causes
``` Abetalipoproteinemia Short gut/resection Poor diet Chronic diarrhea Inflammatory bowel disease/malabsorption Pancreatitis ```
180
What's special about the OPL?
- watershed zone between inner and outer circulation - CME happens in OPL - called Henle's layer in the macula - polarisation responsible for Haidinger Brush phenomenon
181
MPS
Macular laser is good for extra-foveal, juxta-foveal, and also sub-foveal CNV Best results were for POHS
182
TAP
PDT good for sub-foveal CNV with classic or predominately classic (>50% classic)
183
VIP
PDT good for sub-foveal CNV with occult features
184
VISION
Macugen vs sham for sub-foveal CNV Macugen had 77% of patients lose
185
MARINA
M = Minimally classic or occult Bevacizumab vs sham. B group had 95% patients lose
186
ANCHOR
C in anChor = Classic Bevazicumab vs PDT B group had 95% lose
187
CATT
1. Lucentis vs avastin - both were equal in treating CNV - avastin had more cardiovascular events 2. Montly vs PRN - monthly is better than PRN
188
AREDS
``` A 15 mg C 500 mg E 400 mg Zinc 80 mg Cu 2 mg ```
189
ETDRS-2
``` A: none C 500 mg E 400 mg Zinc 80 Cu 2 Lutein 10 Zeaxanthin 2 ``` - got rid of Vit A. Lutein and zeaxanthin just as helpful but without risk to smokers - omega 3 not helpful
190
Risks of various ETDRS vitamins
A: lung ca in smokers E: prostate ca Zinc: stomach upset
191
Risks of various ETDRS vitamins
A: lung ca in smokers E: prostate ca Zinc: stomach upset
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WESDR
After 20 years, 99% of type I and 60% of type II will have some type of DR
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DCCT
Type I DM only - tight BS control worsens maculopathy initially but is better in the long run - best A1C
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UKPDS
Type II DM only (thing UK ppl are overweight, therefore type II) - tight BS control = less DR, less ME
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ETDRS
E is for Edema - defined characteristics of CSME Also said that ASA is not helpful for DR
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DRS
Since there's no E, it's not for edema. Therefore it's for PRP - Defined characteristics of high-risk PDR (3), and said to treat them with PRP. No benefit of PRP in PDR without the high-risk characteristics - Also said that PRP is helpful for severe NPDR (4:2:1)
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RISE/RIDE
Lucentis vs sham for diabetic macular edema (didn't use CSME definitions, just any DME) - lucentis is better than sham
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RESTORE/RESOLVE
Lucentis+laser vs laser alone for DME | - lucentis+laser is better
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DRCR.net - 2 protocols
DRCR.net are the only studies looking at kenalog Protocol I: laser vs kenalog - both are similar but kenalog has more side effects Protocol B: VEGF vs VEGF/laser vs kenalog/laser - VEGF is better. Kenalog=VEGF in pseudophakes only.
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DRVS
Vitrectomy for vit hg in Type I and II - better sooner for type I, better delayed for type II. This may be less valid now as we have more advanced vitrectomy techniques. 7 indications for vitrectomy: 1. Non-clearing VH 2. Chronic, non-resolving CME 3. Combined TRD + RRD 4. TRD involving fovea 5. Ongoing NV despite PRP (removing vit scaffold may help) 6. NV of the anterior hyaloid face 7. Ghost cell glaucoma
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BVOS
Grid laser helpful for CME in BRVO | Criteria: >3/12,
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BRAVO
VEGF vs sham for CME from BRVO | VEGF better
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Treatments for CME in BRVO
VEGF > grid laser > kenalog > observation
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Treatments for CME in CRVO
VEGF > kenalog > observation
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DM is a risk for CRVO or BRVO or both?
Only CRVO. This is from the Eye Disease Case Control Study
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CVOS
No benefit of grid laser in CME from CRVO PRP only if 2 clock hours of NVI (or any NVA, NVE, etc) Risk = 10 DD of non-perfusion Follow CRVO's monthly x 6/12
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CRUISE
VEGF vs sham for CME from CRVO | VEGF better
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SCORE
Triamcinolone better than observation in CRVO, but not better than laser in BRVO BRVO: VEGF > grid laser > kenalog > observation CRVO: VEGF > Kenalog > observation
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SCORE
Triamcinolone better than observation in CRVO, but not better than laser in BRVO BRVO: VEGF > grid laser > kenalog > observation CRVO: VEGF > Kenalog > observation
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Things that autofluoresce
Optic nerve head drusen Dying areas of RPE at the edge of GA (ie GA will enlarge soon) CSR: focal RPE leaks dark, mottling in area of RPE disturbance (??)
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Schisis vs RD
Schisis: - absolute scotoma - smooth surface - no Schaeffer's sign - reacts to laser photocoagulation - fixed, doesn't shift RD: - undulating (shifts) - corrugated surface - relative scotoma - Schaeffer's positive - retinal break - does NOT react to photocoagulation
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Norrie's presentation
Bilateral retro-lental masses X-linked recessive Deafness, MR
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Fundus flavimaticus
Peripheral flecks of the retina > macula Decreased Va only if macula involved AR (like Stargardt)
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North Carolina macular dystrophy
Bilateral macular staphylomas
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Pattern dystrophy
Normal ERG, abnormal EOG (some of them) | Can look like yellow spot at macula, bull's eye, or other blobs
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Best's dz
AD Can get CNV Stages: 1. Pre-vitelliform 2. Egg-yolk (vitelliform) 3. Scrambled egg 4. Psuedo-hypopyon 5. Chorio-retinal atrophy
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Refsum
AR | F = buildup of PHytanic acid, restrict Fats (avoid phytanic acid)
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Abetalipoproteineima
= Bassen Kornzweig disease Can't absorb fat soluble vitamins (ADEK) Rx = supplement with vit A & E. Check stool and blod for apolipoproteins
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Central areolar dystrophy
Bilateral patches of choroidal atrophy (looks like GA) Happens at birth Non-progressive
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Choroideremia
X-linked Carriers can have salt/pepper fundus Both this and gyrate atrophy have scalloped periphery as it starts
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Sticklers
``` Optically empty vitreous Vitreous strands/syneuresis NO RETINOSCHESIS Radial peri-vascular pigment deposition (black dots along vessels) Arthropathy issues (joints etc) ```
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Goldman Favre
``` Like JXLR with RP Enhanced S-cone syndrome: high sensitivity to blue light Optically empty liquified vitreous PSC AR ```
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Goldman Favre
``` Like JXLR with RP Enhanced S-cone syndrome: high sensitivity to blue light Optically empty liquified vitreous PSC AR ```
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Tyrosine in albinism
Tyr + = better disease | Tyr - is more severe disease
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Albinism - syndromes to worry about
Chediak Hegashi: - susceptibility to infections, leukemia/lymphoma Hermansky-Pudlak: - P = platelet disorder in Puerto Ricans
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Aicardi
X-linked Lethal in males Lacunar defects in RPE, severe MR
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X-linked things lethal in males
Aicardi | Incontinentia pigmenti
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Hypercoag workup
``` CBC SPEP Protein C/S Anti-thrombin 3, anti-cardiolipin, anti-phospholipid antibody Factor V leiden Homocysteine levels Lupus anticoagulant C-anca ``` CRAO: never forget GCA workup! CRVO: ask about OCP use
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COMS 5 year survival
Small: 94% Med: 82% Large: 60%
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COMS size definitions
Small: 10 mm thick or >16 mm diam
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COMS conclusions
Small: watch Med: Brachytherapy = enuc. Brachy has lots of vision loss too (50%) Large: pre-enuc radiation is of no benefit. So don't bother.
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Which white dots are M=F?
AMPPE and serpiginous | Rest are all F>M
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Which white dots are unilateral
MEWDS only
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Which white dots have vitritis
Pretty much always: MCP, Birdshot Sometimes: AMPPE (50%) Serpiginous (30%) Never: PIC
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White dots to treat
Birdshot Serpiginous MCP
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Which white dots get CNV
Serpiginous MCP PIC Rarely, AMPPE and Birdshot
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Eales
Bilateral Boys Idiopathic vasculitis Have positive PPD skin test
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Peripheral signs of sickle cell
Sea fans Salmon patch Black sunburst
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West nile
linear multifocal chorioretinitis
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Sticklers
Optically empty vitreous with vitreous strands/syneuresis NO RETINOSCHESIS Radial peri-vascular pigment deposition (black dots along vessels) High myopia, RD's Arthropathy issues (joints etc) It's a type II collagen problem (type II collagen = vitreous)
241
West nile
linear multifocal chorioretinitis
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PORN vs ARN
PORN: - immunocompromised - starts in macula - minimal vitritis ARN: - immunocompetent - starts in peripheral retina - has vitritis
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Batten dz
looks like RP these patients are batty ( = psychosis) bull's eye maculopathy seizures can bx skin
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PCP retinitis
yellow-white placoid lesions looks like AMPPE BUT fa different: - AMPPE: early hypo (blockage), late hyper - PCP: early hyper, late hypo
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Sorsby
looks like AMD in a 30 year old
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What do Behcet die of
Pulmonary anneurysm
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Arden ratio
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POHS features on exam (3)
- punched out chorioretinal lesions - peri-papillary atrophy - no vitritis
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Macular hole - chances in second eye
25% will have bilateral at time of dx if only unilateral,
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BDUMP
- paraneoplastic syndrome (lung, colon, ovarian, uterine) | - bilateral red patches in posterior pole that fluoresce on FA
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Types of macular telangiectasia
I - unilateral, males (like Coats) II - bilat, M=F III - bilat with obliterative capillary non-perfusion Rx with laser, VEGF (best for type I or II)
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Toxoplasmosis in Aids - what do you worry about
get MRI to rule out ring-enhancing brain lesions
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PVR - what do you fill the eye with
Silicone oil = C3F8 SF6 is worse Never put a silicone IOL in a diabetic - gets screwed up if they have a PPV later with silicone oil
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AMPPE - test to order
MRI brain to rule out cerebral vasculitis
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Types of retinal change in CMV
1. Frosted branch angiitis 2. Pizza-pie fundus 3. Peripheral brushfire (granular, yellow-white advancing edge) with peripheral atrophic burned out region
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Drugs to treat CMV retinitis & their risks
Gancyclovir: IV, risk of myelosuppression Valgancyclovir: oral, same risk of myelosuppression Foscarnet, Cidofivir: IV, risks of renal toxicity Can also do intra-vit injections of gan/foscarnet/cidofivir Induction: 2 weeks then maintenance after that
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Intra-ocular calcium ddx
Phthisis (RPE metaplasia) Choroidal osteoma Choroidal hemangioma RB, retinocytoma
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Intra-ocular calcium ddx
``` Phthisis (RPE metaplasia) Choroidal osteoma Choroidal hemangioma RB, retinocytoma ONH drusen Melanoma Meningioma ```
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FA vs ICG
FA: - 376 kDA - absorbs at 475 nm, emits at 525 nm - 80% protein bound - kidney excretion - not safe in 1st trimester ICG: - 775 kDA - absorbs at 805 nm, emits at 835 nm - 98% protein bound - better for choroidal circulation - metabolised in liver - C/I: allergy to iodide/shellfish, liver dz
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Stages of macular hole
I: partial thickness hole II: full thickness III: full thickness with operculum IV: full thickness with PVD Operate for anyone stage II or beyond
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What do you worry about with pseudo-xanthoma elasticum?
``` GI bleeds (get a scope) Choroidal rupture with mild trauma (wear eye protection) ```
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DUSN bugs
BAT: Baylisascaris Ancylostoma Toxocara
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Onchocerciasis rx
- treat with ivermectin - DEC (diethyl carbide) can incide the Mizzuto rxn - intense hyperemia - can be life threatening). Used now as a diagnostic test. Apply a bit to the patient's back and see if it becomes red
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Whipple's disease gives you:
Anterior uveitis | Dx with duodenal biopsy

Ophthalmology (22 decks)

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