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Ophthalmology > Retina > Flashcards

Retina Flashcards

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
Q

Treatable RP’s

A

a

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25
Q

CME that doesn’t leak on FA

A

a

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26
Q

Choroidal mass

A

a

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27
Q

Serous macular RD

A

a

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28
Q

Types of Usher

A

a

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29
Q

Periphlebitis ddx

A

a

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30
Q

Fovea vs foveola (def’n)

A

a

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31
Q

Why do albinos have foveal hypoplasia

A

a

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32
Q

ERM ddx

A

a

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33
Q

EOG abnormal, ERG normal

A

a

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34
Q

Electronegative ERG

A

a

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35
Q

Salt and pepper retinopathy

A

a

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36
Q

Macular dragging

A

a

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37
Q

Frosted branch angiitis

A

a

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38
Q

Cherry red spot

A

a

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39
Q

Flecked retina

A

a

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40
Q

Straightened vessels around macula

A

a

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41
Q

What percentage of macula is rods vs cones?

A

a

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42
Q

What percentage of rods are in the macula?

A

a

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43
Q

Spontaneous vitreous hg

A

a

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44
Q

Foveal hypoplasia

A

a

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45
Q

Angioid streaks

A

a

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46
Q

Exudative RD

A

a

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47
Q

Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each

A

a

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48
Q

Conjunctival vascular anomalies

A

a

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49
Q

Subretinal peripheral black lesions

A

a

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50
Q

ROP mimickers

A

a

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51
Q

Retinal hemorrhage in infancy

A

a

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52
Q

Leopard spots on IVFA

A

a

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53
Q

Roth spots

A

a

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54
Q

ONH drusen ddx

A

a

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55
Q

ONH drusen - findings on exam

A

a

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56
Q

Retinal lipid

A

a

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57
Q

Bilateral macular scars in an infant

A

a

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58
Q

Bone spicule fundus

A

a

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59
Q

Parafoveal telangiectasias

A

a

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60
Q

CSR ddx

A

a

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61
Q

Usher’s ddx (RP-like degen + hearing loss)

A

a

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62
Q

Nyctalopia ddx

A

a

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63
Q

Classic appearing macular toxo lesion

A

a

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64
Q

Indications to treat toxoplasmosis

A

a

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65
Q

Drugs to treat toxoplasmosis

A

a

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66
Q

Multifocal choroiditis

A

a

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67
Q

High risk PDR def’n

A

a

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68
Q

What did ETDRS teach us?

A

a

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69
Q

What did DRS teach us?

A

a

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70
Q

PRP complications

A

a

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71
Q

Severe NPDR?

A

a

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72
Q

What percentage of severe NPDR progress to PDR in 1 year?

A

a

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73
Q

Vit A deficiency causes

A

a

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74
Q

DDx of yellow spot at macula

A 
Macular hole
Best's
Old foveal hemorrhage
Solar retinopaty
Foveal drusen
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75
Q

Causes of retinal vasculitis

A

Infectious

  • syphillis
  • toxoplasmosis
  • CMV
  • TB

Inflammatory

  • Behcet
  • sarcoid
  • SLE
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76
Q

Diseases that give you teeth involvement

A

Peg teeth:

  • incontinentia pigmenti
  • syphillis

Microdontia:
- Axenfeld Reiger

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77
Q

Carriers affected in which diseases

A

Choroideremia
Albinism
X-linked RP

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78
Q

AMD definitions: subfoveal, juxtafoveal, extrafoveal

A

Subfoveal: under the fovea
Juxta foveal: 1-199 um from fovea
Extra foveal: >200 um from fovea

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79
Q

CME ddx

A

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

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80
Q

Choroidal folds ddx

A

THIN RPE

  • choroidal tumors
  • hypotony
  • inflammation
  • NV (CNV)
  • retro-bulbar mass
  • pars planitis
  • extra-ocular hardware
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81
Q

Purtscher’s ddx

A

DEFLATE

  • d
  • emboli of:
  • fluid, fat
  • l
  • amniotic fluid emboli
  • trauma
  • e
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82
Q

Treatable RP’s

A
  • abetalipoproteinemia (vit A & E)
  • refsum’s disease (restrict fat)
  • gyrate atrophy (restrict arginine)
  • vit A deficiency
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83
Q

CME that doesn’t leak on FA

A
  • JXLR
  • nicotinic acid
  • some RP’s
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84
Q

Choroidal mass

A

Nevus/melanoma
Adenoma/adenocytoma
CHRPE

Lymphoma
Mets

Granuloma (toxocara)

CNV, CSR

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85
Q

Serous macular RD

A 
CSR
VKH, SO
Optic nerve pit
CHRRPE
RRD tracking to macula
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86
Q

Types of Usher

A

I - younger onset, more severe hearing loss

II - older onset, variable hearing loss

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87
Q

Periphlebitis ddx

A

a

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88
Q

Fovea vs foveola (sizes)

A 
Fovea = 1.5 mm diam
Foveola = 350 um diam
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89
Q

Why do albinos have foveal hypoplasia

A

Melanin is needed for retinal maturation

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90
Q

ERM ddx

A

VIT

  • vein occlusions
  • idiopathic, inflammatory
  • trauma, tears
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91
Q

EOG abnormal, ERG normal

A
  • Best’s
  • Pattern dystrophy
  • chloroquine, hydroxychloroquine
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92
Q

Electronegative ERG

A

2M, 3C, X/Q

  • myotonic dystrophy
  • MAR
  • CRVO
  • CRAO,
  • CSNB
  • JXLR
  • quinine toxicity
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93
Q

Salt and pepper retinopathy

A
  • RP and all the different types
  • RP carrier
  • rubella
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94
Q

Macular dragging

A
  • ROP
  • FEVR
  • toxocara
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95
Q

Frosted branch angiitis

A
  • CMV

- sarcoid, syphillis, TB

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96
Q

Cherry red spot

A
  • macular hemorrhage
  • CRAO (don’t forget GCA)
  • macular edema
  • macular hole?
  • Tay Sachs
  • Neimann pick
  • Sanders
  • Gaucher
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97
Q

Yellow flecks in the retina

A

More macular:

  • AMD
  • Stargardt
  • Fundus flavimaticus

More peripheral:

  • familial drusen
  • retinitis punctata albescens
  • fundus albipunctatus/CSNB/Oguchi dz
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98
Q

Straightened vessels around macula

A
  • Macular telangiectasia
  • Coats
  • ERM
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99
Q

What percentage of macula is rods vs cones?

A

50% rods, 50% cones in the macula

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100
Q

What percentage of rods are in the macula?

A

5% of all rods are in the macula

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101
Q

Spontaneous vitreous hg

A
  • Sickle cell
  • Trauma
  • Valsalva
  • Purtscher’s
  • Retinal artery macroanneurysm
  • Terson’s
  • Shaken baby
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102
Q

Foveal hypoplasia

A
  • Albinism
  • craniosynostoses?
  • Aniridia
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103
Q

Angioid streaks

A

PEPSI

  • PXE
  • Ehler’s danlos
  • Paget’s disease of bone
  • Sickle cell (& thalassemia)
  • Idiopathic
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104
Q

Exudative RD

A
  • CSR
  • Coats
  • CNV from any cause
  • Macular telangiectasia (IJT)
  • DM
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105
Q

Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each

A

Gene; prevalence; risk of retinopathy

SC; 0.5%; 13%
SThal; ____ ;
AS; ___; 2%
SS; 8%; 0.5%

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106
Q

Conjunctival vascular anomalies

A

Ataxia telangiectasia
Sentinel vessels to underlying uveal melanoma
CCF
SWS
Ocular dermal melanocytosis (nevus of Ota)
Episcleritis, Scleritis

107
Q

Subretinal peripheral black lesions

A 
CHRPE
Laser scars
Nevus
Melanoma
Sicke cell (black sunburst)
108
Q

ROP mimickers

A

FEVR

Incontinentia pigmenti

109
Q

Retinal hemorrhage in infancy

A

Shaken baby, shaken baby, shaken baby
Birth trauma
Bleeding diathesis
Leukemia

110
Q

Leopard spots on IVFA

A

Sarcoid
Mets
Lymphoma

111
Q

Roth spots

A

Leukemia, lymphoma
HIV
Septicemia
Bacterial endocarditis

112
Q

ONH drusen ddx

A

Autosomal dominant

Pseudoxanthoma elasticum

113
Q

ONH drusen - findings on exam

A 
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
Q

Retinal lipid

A

DM

Coats

115
Q

Bilateral macular scars in an infant

A

Toxoplasmosis

CMV

116
Q

Parafoveal telangiectasias

A

NVD/NVE
IJT (macular telangiectasia)
Wyburn Mason

117
Q

CSR ddx

A 
VKH/SO
CNV from any cause
Optic nerve pit
Choroidal mass causing exudation
Hypotony with serous maculopathy
118
Q

Usher’s ddx (RP-like degen + hearing loss)

A

Refsum’s

??

119
Q

Nyctalopia ddx

A

RP or any variant
CSNB, Oguchi disease
Vitamin A deficiency
PRP

120
Q

Classic appearing macular toxo lesion

A

Toxoplasmosis
POHS
??

121
Q

Indications to treat toxoplasmosis

A
  • symptomatic decrease in vision
  • mod-severe vitritis
  • lesions threatening macula or optic nerve
  • acquired infections in pregnancy
  • congenital infections
122
Q

Drugs to treat toxoplasmosis

A
  • pyrimethamine
  • sulfadiazine
  • folinic acid
    +/- steroids

clindamycin, azithromycin
bactrim

sporomycin in pregnancy

123
Q

Multifocal choroiditis

A 
POHS
MCP, PIC
Birdshot
CHRPE from Gardner's syndrome
Mets?
Syphillis, TB
124
Q

High risk PDR def’n

A
  1. NVD > 1/4 - 1/3 DD
  2. any NVD with VH
  3. NVE > 1/2 DD with VH
125
Q

What did ETDRS teach us?

A

E is for Edema
- definition of CSME (usual 3) and when to treat

Also told us that ASA is not helpful for DR

126
Q

What did DRS teach us?

A

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
Q

PRP complications

A
  • 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
Q

Severe NPDR?

A 
421 rule
Any one of:
- 4 quadrants of hemorrhages
- 2 quadrants of venous beading
- 1 quadrant of IRMA
129
Q

What percentage of severe NPDR progress to PDR in 1 year?

A

15%

130
Q

Vit A deficiency causes

A 
Abetalipoproteinemia
Short gut
Poor diet 
Chronic diarrhea
Inflammatory bowel disease
131
Q

CNV ddx

A

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
Q

Crystalline retinopathy ddx

A

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
Q

CWS ddx

A

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
Q

Fundus manifestations of pathologic myopia

A
  • tigroid fundus
  • tilted disc
  • peripapillary atrophy
  • posterior staphyloma
  • lacquer cracks +/- CNV
  • intra-retinal hemorrhages
  • Foster Fuchs spots
  • cystoid, paving stone, or lattice degeneration
135
Q

DDx of NVE

A
  • DM
  • OIS
  • BRVO, CRVO, CRAO
  • Sickle cell
  • CCF
  • ROP/FEVR/Incontinentia pigmenti
  • Eales dz
  • vasculitis (sarcoid, SLE, uveitis, etc)
136
Q

DDx of Bull’s Eye maculopathy

A 
Chloroquine, hydroxychloroquine
AMD
Stargardts
Central areolar macular dystrophy
Cone, cone-rod dystrophies
Pattern dystrophy
Chronic macular hole
137
Q

DDx of yellow spot at macula

A 
Macular hole
Best's
Adult vitelliform dystrophy
Old foveal hemorrhage
Solar retinopaty
Foveal drusen
Pattern dystrophy
CSR, CME
138
Q

Causes of retinal vasculitis

A

Infectious

  • syphillis
  • toxoplasmosis
  • CMV
  • TB
  • ARN
  • Bartonella

Inflammatory

  • Behcet
  • sarcoid
  • SLE
  • Birdshot
  • pars planitis (MS)
  • Eales

Rifabutin

139
Q

Diseases that give you teeth involvement

A

Peg teeth:

  • incontinentia pigmenti (Bloch-Sulzberger)
  • syphillis

Microdontia:
- Axenfeld Reiger

140
Q

Posterior manifestations of sarcoid

A
  • Vitritis
  • Snowbanking
  • candle wax dripping
  • multifocal choroiditis
  • optic nerve swelling
  • posterior scleritis
141
Q

AMD definitions: subfoveal, juxtafoveal, extrafoveal

A

Subfoveal: under the FAZ
Juxta foveal: 1-199 um from fovea
Extra foveal: >200 um from fovea

142
Q

CME ddx

A

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
Q

Choroidal folds ddx

A

THIN RPE

  • choroidal tumors
  • hypotony
  • inflammation
  • NV (CNV)
  • retro-bulbar mass
  • posterior scleritis
  • extra-ocular hardware
144
Q

Purtscher’s ddx

A

DEFLAT-P

  • dermatomyositis
  • emboli of:
  • fluid, fat
  • lupus, leukemia
  • amniotic fluid emboli
  • trauma
  • pancreatitis
145
Q

Treatable RP’s

A
  • abetalipoproteinemia (vit A & E)
  • refsum’s disease (restrict fat)
  • gyrate atrophy (restrict arginine)
  • vit A deficiency
  • DUSN (unilateral)
146
Q

CME that doesn’t leak on FA

A
  • JXLR, Goldman Favre
  • nicotinic acid
  • Leber’s stellate neuroretinitis
  • some RP’s
  • LHON: disc doesn’t leak even though it looks inflamed
147
Q

Choroidal mass

A

Pigmented:

  • Nevus/melanoma
  • Adenoma/adenocytoma
  • CHRPE

Non-pigmented:

  • amelanotic melanoma
  • choroidal osteoma

Lymphoma
Mets

Granuloma (toxocara)

CNV, CSR

148
Q

Serous macular RD

A 
CSR
VKH, SO
Optic nerve pit
Uveal effusions
CHRRPE
RRD tracking to macula
CNV
149
Q

Types of Usher

A

I - younger onset (1st-2nd decade), profound deafness

II - older onset (2nd-4th decade), partial deafness

150
Q

Fovea vs foveola (sizes)

A 
Fovea = 1.5 mm diam
Foveola = 350 um diam (FAZ)
151
Q

Why do albinos have foveal hypoplasia

A

Melanin is needed for retinal development @ 6 weeks GA

152
Q

ERM ddx

A

VIT

  • vein occlusions
  • idiopathic, inflammatory
  • trauma, tears
153
Q

EOG abnormal, ERG normal

A
  • Best’s
  • Pattern dystrophy
  • chloroquine, hydroxychloroquine
154
Q

Electronegative ERG

A

2M, 3C, X/Q

  • myotonic dystrophy
  • MAR
  • CRVO
  • CRAO
  • CSNB
  • JXLR
  • quinine toxicity
155
Q

Salt and pepper retinopathy

A
  • RP and all the different types
  • carriers (RP, choroideremia, albinism)
  • rubella, syphillis, varicella
156
Q

Macular dragging

A
  • ROP
  • FEVR
  • incontinentia pigmenti
  • toxocara
157
Q

Frosted branch angiitis

A
  • CMV
  • leukemia, lymphoma
  • TB
158
Q

Cherry red spot

A
  • CRAO (don’t forget GCA)
  • macular commotio
  • macular hole
  • macular hemorrhage
  • Tay Sachs
  • Neimann pick
  • Sandhoff
  • Gaucher
159
Q

Straightened vessels around macula

A
  • Macular telangiectasia
  • ERM
  • ROP, FEVR, IP, toxocara
160
Q

What is the histological definition of the macula

A

2 layers of GCL

161
Q

What are the layers of the retina

A 
ILM
NFL
GCL
IPL
INL
OPL
ONL
ELM
PR's
RPE
Bruch's
162
Q

What’s special about the OPL?

A
  • 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
Q

Spontaneous vitreous hg

A
  • 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
Q

Foveal hypoplasia

A
  • Albinism

- Aniridia

165
Q

Exudative RD

A
  • CSR
  • Coats
  • CNV from any cause
  • Macular telangiectasia (IJT)
  • DM
  • VHL
  • idiopathic uveal effusions
166
Q

Types of sickle cell genetics, prevalence in black population, and risk of retinopathy of each

A

Gene; prevalence; risk of retinopathy

SC; 0.5%; 33%
SThal; ____ ; 14%
SS; ___; 3%
SA; 8%; rare

167
Q

Conjunctival vascular anomalies

A

Ataxia telangiectasia
Sentinel vessels to underlying uveal melanoma
CCF
SWS
Ocular dermal melanocytosis (nevus of Ota)
Episcleritis, Scleritis

168
Q

ROP mimickers

A

FEVR
Incontinentia pigmenti
Sickle cell

169
Q

Retinal hemorrhage in infancy

A 
Shaken baby, shaken baby, shaken baby
Birth trauma
Bleeding diathesis
Leukemia
CPR
170
Q

Leopard spots on IVFA

A

Mets
Lymphoma, leukemia
Uveal effusion syndrome
BDUMP

171
Q

Roth spots

A 
Leukemia, lymphoma
HIV
Septicemia
Bacterial endocarditis
Shaken baby, birth trauma
172
Q

Retinal lipid

A 
DM, radiation
Coats
HTN
Papilledema
Macular star
VHL
173
Q

CSR ddx

A 
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
Q

Usher’s ddx (RP-like degen + hearing loss)

A 
Refsum's
Congenital rubella
congenital syphillis
Eales
X-linked albinism can have hearing loss
175
Q

Nyctalopia ddx

A

RP or any variant (incl Lebers congenital amaurosis)
CSNB, Oguchi disease
Vitamin A deficiency
PRP

176
Q

Classic appearing macular toxo lesion

A 
Toxoplasmosis
POHS
Serpiginous
Sarcoid
Endophthalmitis
177
Q

Multifocal choroiditis

A 
POHS
MCP, PIC, Birdshot, MEWDS
CHRPE from Gardner's syndrome
Mets?
Syphillis, TB, lyme
178
Q

What did ETDRS teach us?

A

E is for Edema
- definition of CSME

Also told us that ASA is not helpful for DR

179
Q

Vit A deficiency causes

A 
Abetalipoproteinemia
Short gut/resection
Poor diet 
Chronic diarrhea
Inflammatory bowel disease/malabsorption
Pancreatitis
180
Q

What’s special about the OPL?

A
  • 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
Q

MPS

A

Macular laser is good for extra-foveal, juxta-foveal, and also sub-foveal CNV
Best results were for POHS

182
Q

TAP

A

PDT good for sub-foveal CNV with classic or predominately classic (>50% classic)

183
Q

VIP

A

PDT good for sub-foveal CNV with occult features

184
Q

VISION

A

Macugen vs sham for sub-foveal CNV

Macugen had 77% of patients lose

185
Q

MARINA

A

M = Minimally classic or occult

Bevacizumab vs sham.
B group had 95% patients lose

186
Q

ANCHOR

A

C in anChor = Classic
Bevazicumab vs PDT

B group had 95% lose

187
Q

CATT

A
  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
Q

AREDS

A 
A 15 mg
C 500 mg
E 400 mg
Zinc 80 mg
Cu 2 mg
189
Q

ETDRS-2

A 
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
Q

Risks of various ETDRS vitamins

A

A: lung ca in smokers
E: prostate ca
Zinc: stomach upset

191
Q

Risks of various ETDRS vitamins

A

A: lung ca in smokers
E: prostate ca
Zinc: stomach upset

192
Q

WESDR

A

After 20 years, 99% of type I and 60% of type II will have some type of DR

193
Q

DCCT

A

Type I DM only

  • tight BS control worsens maculopathy initially but is better in the long run
  • best A1C
194
Q

UKPDS

A

Type II DM only (thing UK ppl are overweight, therefore type II)
- tight BS control = less DR, less ME

195
Q

ETDRS

A

E is for Edema
- defined characteristics of CSME

Also said that ASA is not helpful for DR

196
Q

DRS

A

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)
197
Q

RISE/RIDE

A

Lucentis vs sham for diabetic macular edema (didn’t use CSME definitions, just any DME)

  • lucentis is better than sham
198
Q

RESTORE/RESOLVE

A

Lucentis+laser vs laser alone for DME

- lucentis+laser is better

199
Q

DRCR.net - 2 protocols

A

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.

200
Q

DRVS

A

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
201
Q

BVOS

A

Grid laser helpful for CME in BRVO

Criteria: >3/12,

202
Q

BRAVO

A

VEGF vs sham for CME from BRVO

VEGF better

203
Q

Treatments for CME in BRVO

A

VEGF > grid laser > kenalog > observation

204
Q

Treatments for CME in CRVO

A

VEGF > kenalog > observation

205
Q

DM is a risk for CRVO or BRVO or both?

A

Only CRVO. This is from the Eye Disease Case Control Study

206
Q

CVOS

A

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

207
Q

CRUISE

A

VEGF vs sham for CME from CRVO

VEGF better

208
Q

SCORE

A

Triamcinolone better than observation in CRVO, but not better than laser in BRVO

BRVO: VEGF > grid laser > kenalog > observation
CRVO: VEGF > Kenalog > observation

209
Q

SCORE

A

Triamcinolone better than observation in CRVO, but not better than laser in BRVO

BRVO: VEGF > grid laser > kenalog > observation
CRVO: VEGF > Kenalog > observation

210
Q

Things that autofluoresce

A

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 (??)

211
Q

Schisis vs RD

A

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
212
Q

Norrie’s presentation

A

Bilateral retro-lental masses
X-linked recessive
Deafness, MR

213
Q

Fundus flavimaticus

A

Peripheral flecks of the retina > macula
Decreased Va only if macula involved
AR (like Stargardt)

214
Q

North Carolina macular dystrophy

A

Bilateral macular staphylomas

215
Q

Pattern dystrophy

A

Normal ERG, abnormal EOG (some of them)

Can look like yellow spot at macula, bull’s eye, or other blobs

216
Q

Best’s dz

A

AD
Can get CNV

Stages:

  1. Pre-vitelliform
  2. Egg-yolk (vitelliform)
  3. Scrambled egg
  4. Psuedo-hypopyon
  5. Chorio-retinal atrophy
217
Q

Refsum

A

AR

F = buildup of PHytanic acid, restrict Fats (avoid phytanic acid)

218
Q

Abetalipoproteineima

A

= Bassen Kornzweig disease
Can’t absorb fat soluble vitamins (ADEK)
Rx = supplement with vit A & E.
Check stool and blod for apolipoproteins

219
Q

Central areolar dystrophy

A

Bilateral patches of choroidal atrophy (looks like GA)
Happens at birth
Non-progressive

220
Q

Choroideremia

A

X-linked
Carriers can have salt/pepper fundus
Both this and gyrate atrophy have scalloped periphery as it starts

221
Q

Sticklers

A 
Optically empty vitreous
Vitreous strands/syneuresis
NO RETINOSCHESIS
Radial peri-vascular pigment deposition (black dots along vessels)
Arthropathy issues (joints etc)
222
Q

Goldman Favre

A 
Like JXLR with RP
Enhanced S-cone syndrome: high sensitivity to blue light
Optically empty liquified vitreous
PSC
AR
223
Q

Goldman Favre

A 
Like JXLR with RP
Enhanced S-cone syndrome: high sensitivity to blue light
Optically empty liquified vitreous
PSC
AR
224
Q

Tyrosine in albinism

A

Tyr + = better disease

Tyr - is more severe disease

225
Q

Albinism - syndromes to worry about

A

Chediak Hegashi:
- susceptibility to infections, leukemia/lymphoma

Hermansky-Pudlak:
- P = platelet disorder in Puerto Ricans

226
Q

Aicardi

A

X-linked
Lethal in males
Lacunar defects in RPE, severe MR

227
Q

X-linked things lethal in males

A

Aicardi

Incontinentia pigmenti

228
Q

Hypercoag workup

A 
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

229
Q

COMS 5 year survival

A

Small: 94%
Med: 82%
Large: 60%

230
Q

COMS size definitions

A

Small: 10 mm thick or >16 mm diam

231
Q

COMS conclusions

A

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.

232
Q

Which white dots are M=F?

A

AMPPE and serpiginous

Rest are all F>M

233
Q

Which white dots are unilateral

A

MEWDS only

234
Q

Which white dots have vitritis

A

Pretty much always:
MCP, Birdshot

Sometimes:
AMPPE (50%)
Serpiginous (30%)

Never: PIC

235
Q

White dots to treat

A

Birdshot
Serpiginous
MCP

236
Q

Which white dots get CNV

A

Serpiginous
MCP
PIC

Rarely, AMPPE and Birdshot

237
Q

Eales

A

Bilateral
Boys
Idiopathic vasculitis
Have positive PPD skin test

238
Q

Peripheral signs of sickle cell

A

Sea fans
Salmon patch
Black sunburst

239
Q

West nile

A

linear multifocal chorioretinitis

240
Q

Sticklers

A

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
Q

West nile

A

linear multifocal chorioretinitis

242
Q

PORN vs ARN

A

PORN:

  • immunocompromised
  • starts in macula
  • minimal vitritis

ARN:

  • immunocompetent
  • starts in peripheral retina
  • has vitritis
243
Q

Batten dz

A

looks like RP
these patients are batty ( = psychosis)
bull’s eye maculopathy
seizures

can bx skin

244
Q

PCP retinitis

A

yellow-white placoid lesions
looks like AMPPE

BUT fa different:

  • AMPPE: early hypo (blockage), late hyper
  • PCP: early hyper, late hypo
245
Q

Sorsby

A

looks like AMD in a 30 year old

246
Q

What do Behcet die of

A

Pulmonary anneurysm

247
Q

Arden ratio

A
248
Q

POHS features on exam (3)

A
  • punched out chorioretinal lesions
  • peri-papillary atrophy
  • no vitritis
249
Q

Macular hole - chances in second eye

A

25% will have bilateral at time of dx

if only unilateral,

250
Q

BDUMP

A
  • paraneoplastic syndrome (lung, colon, ovarian, uterine)

- bilateral red patches in posterior pole that fluoresce on FA

251
Q

Types of macular telangiectasia

A

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)

252
Q

Toxoplasmosis in Aids - what do you worry about

A

get MRI to rule out ring-enhancing brain lesions

253
Q

PVR - what do you fill the eye with

A

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

254
Q

AMPPE - test to order

A

MRI brain to rule out cerebral vasculitis

255
Q

Types of retinal change in CMV

A
  1. Frosted branch angiitis
  2. Pizza-pie fundus
  3. Peripheral brushfire (granular, yellow-white advancing edge) with peripheral atrophic burned out region
256
Q

Drugs to treat CMV retinitis & their risks

A

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

257
Q

Intra-ocular calcium ddx

A

Phthisis (RPE metaplasia)
Choroidal osteoma
Choroidal hemangioma
RB, retinocytoma

258
Q

Intra-ocular calcium ddx

A 
Phthisis (RPE metaplasia)
Choroidal osteoma
Choroidal hemangioma
RB, retinocytoma
ONH drusen
Melanoma
Meningioma
259
Q

FA vs ICG

A

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
260
Q

Stages of macular hole

A

I: partial thickness hole
II: full thickness
III: full thickness with operculum
IV: full thickness with PVD

Operate for anyone stage II or beyond

261
Q

What do you worry about with pseudo-xanthoma elasticum?

A 
GI bleeds (get a scope)
Choroidal rupture with mild trauma (wear eye protection)
262
Q

DUSN bugs

A

BAT:
Baylisascaris
Ancylostoma
Toxocara

263
Q

Onchocerciasis rx

A
  • 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
264
Q

Whipple’s disease gives you:

A

Anterior uveitis

Dx with duodenal biopsy

Ophthalmology (22 decks)

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