RETINA - VITREOUS-RETINA INTERFACE SPLITTING

Question 1

what are 3 types of retinal breaks?

Answer 1

1. horseshoe tear
2. operculated hole
3. atrophic hole

Question 2

what is a horseshoe tear?

Answer 2

It is a full thickness retinal break/defect caused by vitreoretinal traction - An overlying flap is present because of uneven vitreous traction.

Question 3

where is the most common location for a horseshoe tear to occur?

Answer 3

1. superior temporal
2. superior nasal

Question 4

what is an operculated hole?

Answer 4

• It is a symmetrical retinal tear resulting from an even vitreoretinal traction that pulls piece of the retinal tissue - the overlying piece of tissue is called an operculum (smaller than the tear).

Question 5

what is an atrophic hole?

Answer 5

• It’s a round, often small, full-thickness defect that are caused by chronic atrophy of the sensory retina.

Question 6

where is the most common location for a atrophic tear to occur?

Answer 6

1. superior temporal

Question 7

what retinal break has a higher chance of causing a retinal detachment?
* list the retinal breaks in order of greatest to least

Answer 7

horseshoe > operculum > atrophic

Question 8

what is the % chance a horseshow tear will cause an RD?

Answer 8

30-50%

Question 9

why does a horseshoe tear have a higher chance of causing a RD?

Answer 9

b/c vitreoretinal traction remains after the tear occurs

Question 10

why is an operculated hole less likely to cause a RD?

Answer 10

After forming the tear, the vitreous pulls away and the vitreoretinal traction no longer persist –> this reduces the risk for a retinal detachment to occur.

Question 11

what is a RD?

Answer 11

detachment of the sensory (neural) retina from the RPE?

Question 12

what are the 2 type of broad retinal detachment categories?

Answer 12

1. rhegmatogenous RD
2. non-rhegmatogenous RD

Question 13

what are rhegmatogenous RD caused by?

Answer 13

these are caused by V-R traction which leads to a retinal break (horseshoe tear, operculum, atrophic hole).

Question 14

who gets retinal breaks/RRD?

Answer 14

• M>F
• > 45y/o

Question 15

what are the risk factors for retinal break/RRD?

Answer 15

• high Myopia (40%)
• FHx
• PVD (10-15%)
• Trauma (5-10%)
• Ocular Sx
• Lattice degeneration (1%)

Question 16

what are symptoms of RB/RRD?

Answer 16

• flashes
• floaters that move w/ eye movment
• curtain/veil in vision
• missing areas of vision

Question 17

what are signs of RD?

Answer 17

Acute:
* schaeffer’s sign - in vitreous
* ripples in retina
* horseshoe tear/operculum
* macula on or off

Longstanding:
* pigment demarcation line at detachment sight (works as a seal)

Question 18

Tx for RRD?

Answer 18

macula off:
* urgent (24-72 hrs) referral

macula on:
* emergent (same day) referral

Surgical Tx –> laser photocoagulation (PRP)/cryotherapy/penumatic retinopexy/vitrectomy/scleral buckle

Question 19

Tx for retinal break (RB)?

Answer 19

acute - urgent (24-72 hrs) referral for laser photocoagulation or cryotherapy.

chronic - monitor yearly with DFE and fundus photos. Educate pt of s/s of RD.

Question 20

what are the 2 types of non-rhegmatogenous RD?

Answer 20

1. serous RD
2. tractional RD

Question 21

why are serous and tactional RD consider non-rhegamtogenous?

Answer 21

these are not caused by a retinal tear or hole.

Question 22

define serous RD.

Answer 22

• Type of RD that results from subretinal disorders that damage the BRB (RPE) and allow fluid to accumulate under the retina (subretinal space).

Question 23

what is the cause of serous RD?

Answer 23

caused by systemic disease:
* CHBALA
* CSR
* Coat’s Dz
* choroidal melanoma
* optic pit
* morning glory syndrome

Question 24

what is tractional RD?

Answer 24

Its neovascularization that grows from retina to vitreous. This causes traction between retina and vitreous

Question 25

how does tractional RD occur?

Answer 25

occurs when neovascularization from the retina grows into the vitreous causing the two to be "connected." This creates potential for traction to occur everytime the vitreous contracts/moves. * If the vitreous breaks the neovascular blood vessels --> it will lead to **pre-retinal heme.** * If the vitreous tears ---> neo blood vessels also rip and this causes **vitreous heme.** * If the retina tears --> then fluid can accumulate underneath the retina leading to a **tractional RD**.

Question 26

what causes tractional RD?

Answer 26

any disease that can cause neovascularization (DR.VOS): * DM * ROP * vascular occlusion * OIS * sickle cell retinopathy

Question 27

tx for tractional RD?

Answer 27

same as RRD: acute - urgent (24-72 hrs) referral for PRP or cryotherapy. chronic - monitor yearly with DFE and fundus photos. Educate pt of s/s of RD.

Question 28

what is retinoschisis?

Answer 28

It is splitting of the layers **within** the retina.

Question 29

what layers are split in retinoschisis?

Answer 29

the OPL & INL

Question 30

what location does retinoschisis commonly occur?

Answer 30

inferior-temporal retina

Question 31

what are the 2 forms of retinoschisis?

Answer 31

1. congential juvenile x-linked recessive 2. acquired are related

Question 32

define juvenile x-linked retinoschisis.

Answer 32

Juvenile retinoschisis is characterized by bilateral maculopathy  with  associated peripheral  retinoschisis in 50%.

Question 33

where does splitting occur in juvenile x-linked recessive retinoschisis?

Answer 33

splitting occurs in the NFL.

Question 34

what type of maculopathy is associated with congenital retinoschisis?

Answer 34

Foveal schisis seen as stellate maculopathy - spoke like foveal cysts.

Question 35

signs of congenital retinoschisis?

Answer 35

* nystagmus * vit heme * pigmentary changes may also occur. * Pigmented demarcation lines can be seen (indicating previous RD

Question 36

define acquired age related retinoschisis.

Answer 36

bilateral and symmetrical splitting occurs at OPL.

Question 37

what is the work-up done for retinoschisis?

Answer 37

* DFE w/scleral depression * OCT to determine layers of separation.

Question 38

tx for retinoschisis?

Answer 38

* no tx for retinoschisis. * vitrectomy - for vitreous heme. * amblyopia prevention * congenital retinoschisis - edu child to avoid physical activity to prevent RD or hemes.

Question 39

when do you want to see retinoschisis patient back?

Answer 39

6 months

Question 40

what type of VF defect does retinoschisis produce? How about RD?

Answer 40

* absolute VF defect * RD - relative VF defect