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Duke Elder 2020 > Vitreoretinal > Flashcards

Vitreoretinal Flashcards

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1
Q

What is peripheral retinal degeneration?

A

abnormalities in the peripheral retina

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2
Q

What is lattice degeneration?

A

THINNING IN THE NEUROSENSORY RETINA

WITH OVERLYING VITREOUS LIQUEFACTION

VITREORETINAL ADHESIONS CHARACTERISED BY CIRCUMFERENTIAL ZIGZAG WHITE LINES WITH OVAL HOLES WITHIN THE LESION

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3
Q

What is the most important degeneration predisposing to retinal tears?

A

lattice degeneration

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4
Q

In what population is lattice degeneration most common?

A

6-10% of normal population and more common in myopic eyes

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5
Q

What % of people with rhegmatogenous retinal detachment have lattice degeneration?

A

30%

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6
Q

How is lattice degeneration managed?

A

PROPHYLACTIC TREATMENT ONLY IN PATIENTS WITH A RETINAL DETACHMENT IN THE CONTRALATERAL EYE,

IN THE FORM OF LASER RETINOPEXY

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7
Q

What is degenerative retinoschisis?

A

MICROCYTIC DEGENERATION RESULTING IN THE SPLITTING OF THE RETINAL LAYERS BETWEEN THE OUTER PLEXIFORM AND INNER NUCLEAR LAYERS, USUALLY INFEROTEMPORALLY

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8
Q

Describe the distribution of retinoschisis

A

mostly bilateral and symmeterical

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9
Q

In what type of eye is retinoschisis most common?

A

Hypermetropic,

not frequently associated with RRD

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10
Q

Describe the features of retinoschisis

A

SMOOTH CONVEX AND IMMOBILE ELEVATION OF RETINA WITH NO DEMARCATION LINE OF CHRONICITY WITH RRD

ASSOCIATED WITH ABSOLUTE FIELD DEFECT

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11
Q

What is posterior vitreous detachment?

A

SEPARATATION OF THE POSTERIOR VITREOUS CORTEX FROM THE NSR

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12
Q

What factors increase the likelihood of posterior vitreous detachment?

A

OCCURS WITH INCREASING AGE AS THE VITREOUS BECOMES MORE LIQUEFIED (SYNCHYSIS) WHICH RESULTS IN THE CREATION OF EMPTY POCKETS OF FLUID WITHIN THE VITREOUS, LEADING TO VITREOUS COLLAPSE

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13
Q

Describe the pathogenesis of posterior vitreous detachment

A

VITREOUS BECOMES MORE LIQUEFIED (SYNCHYSIS) WHICH RESULTS IN THE CREATION OF EMPTY POCKETS OF FLUID WITHIN THE VITREOUS, LEADING TO VITREOUS COLLAPSE

EVENTUALLY FLUID ESCAPES IN THE RETROVITREOUS SPACE SEPARATING THE POSTERIOR HYALOID FROM THE NSR

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14
Q

What are the features of posterior vitreous detachment?

A

PHOTOPSIA WITH ASSOCIATED FLOATERS, VA USUALLY UNAFFECTED

WEISS RING: THICKENED VITREOUS AVULSED FROM OPTIC DISC

SHAFER SIGN (PIGMENTED PARTICLES OR ‘TOBACCO DUST’ IN THE ANTERIOR VITREOUS) NEGATIVE

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15
Q

How is posterior vitreous detachment managed?

A

DOES NOT REQUIRE TREATMENT

WARN ABOUT RISK OF Rhegomatogenous RD AND ADVICE ON PRESENTING IMMEDIATELY IF SYMPTOMS WORSEN OR VISUAL FIELD IS AFFECTED

IF COMPLICATED WITH RETINAL TEAR, TREAT WITH LASER OR CRYORETINOPEXY

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16
Q

What are retinal breaks?

A

THESE ARE FULL-THICKNESS RETINAL DEFECTS, PROGRESSION TO RD IS RARE

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17
Q

Under what conditions can retinal breaks be treated?

A

High risk of RD:

  • HIGH MYOPIA > 6D
  • APHAKIA
  • GIANT RETINAL TEAR
  • SYMPTOMATIC U-SHAPED RETINAL TEAR
  • SYSTEMIC DISEASE
  • STICKLER SYNDROME
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18
Q

What is a retinal tear?

A

A U-SHAPED DEFECT DUE TO VITREORETINAL TRACTION ON A STRIP OF RETINA DUE TO posterior vitreous detachment

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19
Q

In what percentage of cases do retinal tears progress to RRD?

A

1/3

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20
Q

What can retinal breaks be associated with?

A

VITREORETINAL ADHESIONS SUCH AS AT THE MARGINS OF LATTICE DEGENERATION

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21
Q

What are the features of retinal breaks?

A

FLASHES

FLOATERS

WEISS RING

SHAFER SIGN POSITIVE

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22
Q

How are symptomatic retinal breaks treated?

A

laser retinopexy

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23
Q

What is a giant retinal tear?

A

A RETINAL TEAR EXTENDING >/ 3 CLOCK HOURS > 90 DEGREES

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24
Q

Where do giant retinal tears occur?

A

PERIPHERAL RETINA AT POSTERIOR BORDER VITREOUS

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25
What are giant retinal tears associated with?
TRAUMA HIGH MYOPIA DISEASES E.G. MARFAN / STICKLER SYNDROME
26
how are giant retinal tears managed?
LASER RETINOPEXY FOR BOTH EYES
27
in what % of cases are giant retinal tears bilateral and in what % of cases are their retinal tears in the fellow eye?
16.5% and 60%
28
What is retinal dialysis?
A DISINSERTION OF THE RETINA AT THE ORA SERRATA INVOLVING ANTERIOR AND POSTERIOR TO THE VITREOUS BASES
29
What is the most common type of retinal dialysis and where does it occur?
TRAUMATIC RETINAL DIALYSIS IS MORE COMMON AND LOCATED SUPERONASALLY
30
Where does idiopathic retinal dialysis occur more commonly?
inferotemporally
31
What is the leading cause of traumatic retinal detachment in children and young adults?
Retinal dialysis
32
how is retinal dialysis managed?
LASER RETINOPEXY IF THERE IS NO ASSOCIATED RD, OTHERWISE SCLERAL BUCKLE IS USED
33
What is retinal detachment?
SEPARATION OF THE NSR FROM THE RPE
34
What is shifting sub-retinal fluid?
following detachment, SUBSEQUENT SHIFT OF SUB RETINAL FLUID IN THE SPACE BETWEEN THE NSR AND THE RPE
35
What are the three main types of retinal detachment?
RRD, TRACTIONAL RD AND EXUDATIVE RD
36
What is the most common form of retinal detachment?
RRD
37
Describe the pathogenesis of RRD
retinal break - FLUID SEEPS IN BETWEEN THE NSR AND RPE CAUSING A DETACHMENT this is an emergency, can cause blindess
38
What are the features of rhegmatogenous retinal detachment?
FLASHES AND FLOATER CURTAIN-LIKE VISUAL FIELD LOSS (RELATIVE FIELD LOSS) DVA IF MACULA IS INVOLVED RAPD, WEISS RING AND SHAFER SIGN PRESENCE OF PVD AND RETINAL BREAKS (COMMONLY A U-SHAPED RETINAL TEAR; MOST COMMON LOCATION IN SUPERTEMPORAL)
39
Describe fresh RRD
- CONVEX CORRUGATED DOME-SHAPED SURFACE WITH LOSS OF RPE MARKINGS SHAPE BASED ON MOST SUPERIOR RETINAL BREAK EXTEND FROM ORA SERRATA TO OPTIC DISC THEY ARE PROGRESSIVE AND MAY AFFECT MACULA
40
Describe chronic RRD
RETINAL THINNING DEMARCATION LINES INTRARETINAL CYSTS PROLIFERATIVE VITREORETINOPATHY
41
What investigations are used for RRD?
SLIT LAMP BIOMICROSCOPY WITH WIDE-FIELD LENS INDIRECT OPHTHALMOSCOPY WITH SCLERAL DEPRESSION TO VISUALISE THE ORA SERRATA B-SCAN USS IS NO VIEW OF POSTERIOR POLE SUCH AS DENSE CATARACT OR VITREOUS HAEMORRHAGE
42
What is the management for RRD?
VITRECTOMY: MOST COMMON PROCEDURE, INDICATED FOR POSTERIOR RETINAL BREAKS, GIANT RETINAL TEARS AND PROLIFERATIVE VITREORETINOPATHY SCLERAL BUCKLE: VERY HIGH SUCCESS RATE, USED IN SIMPLE RRD AND RETINAL DIALYSIS WHEN THERE IS ANO PRE-EXISTING PVD PNEUMATIC RETINOPEXY: LOWER SUCCESS RATE BUT ALSO FEWER SIDE EFFECTS; USED IN CAREFULLY SELECTED CASES WITH SMALL SUPERIOR BREAKS 1 CLOCK HOUR APART BETWEEN 11 AND 1 CLOCK HOURS
43
What is tractional retinal detachment?
THIS IS DUE TO VITREORETINAL TRACTION
44
describe the pathogenesis of tractional retinal detachment
INSIDIOUS PROCESS WHERE FIBROVASCULAR MEMBRANES CAUSE PROGRESSIVE CONTRACTURE OVER AREAS OF ADHESIONS EVENTUALLY CAUSING A DETACHMENT
45
What are the most common causes of tractional retinal detachment?
ADVANCED PROLIFERATIVE DIABETIC RETINOPATHY AND ROP
46
What are the features of tractional retinal detachment?
USUALLY ASYMPTOMATIC (NO FLASHES OR FLOATERS) AS THERE IS NO PVD VA AFFECTED ONCE MACULA IS THREATENED CAUSING DISTORTION OF VISION DETACHMENT: SHALLOW IMMOBILE CONCAVE TENTING OF RETINA MINIMAL SHIFTING SRF ASSOCIATED RELATIVE VISUAL FIELD LOSS, SIGNS OF UNDERLYING DISEASE
47
What is the management of tractional retinal detachment?
VITRECTOMY WITH MEMBRANE PEEL
48
What is exudative retinal detachment?
THIS RARE FORM OF RD OCCURS DUE TO BUILDUP OF SRF FROM DAMAGE TO THE OUTER BLOOD-RETINAL BARRIER
49
Describe the pathogenesis of exudative retinal detachment
FLUID LEAKAGE OCCURS UNDER THE RETINA THEREBY SEPARATING THE NSR FROM THE RPE OCCURS WHEN THE COMPENSATORY MECHANISMS OF THE RPE FAILED TO PUMP THE FLUID BACK INTO THE CHOROIDAL CIRCULATION
50
What are some causes of exudative retinal detachment?
TUMOURS: CHOROIDAL TUMOURS IDIOPATHIC: NANOPTHALMIA LEADING TO UVEAL EFFUSION SYNDROME VASCULAR: EXUDATIVE AGE-RELATED MACULAR DEGENERATION, COATS' DISEASE, CENTRAL SEROUS CHORIORETINOPATHY
51
What are some inflammatory causes of exudative retinal detachment?
POSTERIOR UVEITIS: SYMPATHETIC OPTHALMIA AND Vogt-kayanadi-harada POSTERIOR SCLERITIS, ORBITAL INFLAMMTORY DISEASE, POSTOP INFLAMMATION AND EXTENSIVE PAN RETINAL PHOTOCOAGULATION
52
What are some features of exudative retinal detachment?
FLOATERS IF VITRITIS PRESENT, dVA IS AFFECTED RD: SMOOTH CONVEX THAT IS SHALLOW OR BULLOUS, LACK OF PVD AND RETINAL TEARS AND EVIDENCE OF TRACTION EVIDENCE OF UNDERLYING CONDITION
53
How is exudative retinal detachment managed?
OPTHALMIC AND SYSTEMIC HISTORY AND EXAMINATION INCLUDING BLOOD PRESSURE AND URINALYSIS TREATMENT OF UNDERLYING CAUSE TREATS THE RETINAL DETACHMENT; SURGERY NOT USUALLY INDICATED
54
What is vitreous haemorrhage?
THIS IS BLEEDING INTO THE VITREOUS CHAMBER MAY BE DUE TO TWO BASIC MECHANISMS; RUPTURE OF VESSELS THORUGH TRAUMA OR BLEEDING FROM PATHOLOGICAL PROCESSES
55
What are some causes of vitreous haemorrhage?
TRAUMA : - BLUNT OR PENETRATING TRAUMA CAUSING CLOSED OR OPEN GLOBE INJURY - SHAKED BABY SYNDROME - ACUTE PVD ASSOCIATED WITH VITREOUS HAEMORRHAGE NEOVASCULARISATION LEADING TO HAEMORRHAGE: - DIABETIC RETINOPATHY - SICKLE CELL RETINOPATHY --ROP - WET ARMD - RETINAL VEIN OCCLUSION OTHER: CHOROIDAL TUMOURS
56
What investigations are used for vitreous haemorrhage?
ALL PATIENTS NEED A DETAILED FUNDAL EXAMINATION TO ASSESS THE SEVERITY OF HAEMORRHAGE AND EXCLUDE RETINAL TEARS
57
What is the management for vitreous haemorrhage?
DEPENDENT ON CAUSE PAN-RETINAL PHOTOCOAGULATION IF THERE IS A FUNDAL VIEW INTRAVITREAL ANTI-VEGF IF THERE IS NO FUNDAL VIEW OR IN WET ARMD PARS PLANA VITRECTOMY; OFTEN PRE-TREATED WITH INTRAVITREAL ANTI-VEGF FOR NON-CLEARING VITREOUS HAEMORRHAGE OR IN PRESENCE OF RETINAL DETACHMENT
58
What is choroidal detachment?
A DETACHMENT OF THE CHOROID FROM THE SCLERA DUE TO THE ACCUMULATION OF FLUID OR BLOOD IN THE SUPRACHOROIDAL SPACE
59
What are some causes of choroidal detachment?
ACUTE HYPOTONY (IOP<5mmHg), TYPICALLY FOLLOWING GLAUCOMA SURGERY TRAUMA
60
what are the features of choroidal detachment?
SMOOTH, DARK AND CONVEX ELEVATION ARISING FROM THE PERIPHERY LARGE 'KISSING' CHOROIDAL DETACHMENTS CAN LEAD TO RD
61
What is choroidal rupture?
A BREAK IN THE CHOROID MAY RESULT FROM CLOSED GLOBE INJURY DUE TO BLUNT TRAUMA
62
Describe the features of choroidal rupture
THERE IS USUALLY DISRUPTION OF THE CHOROID, BRUCH MEMBRANE AND RPE; HOWEVER THE NEUROSENSORY RETINAL IS UNAFFECTED ON EXAMINATION, A CRESCENT-SHAPED YELLOW SUBRETINAL STREAK IS SEEN USUALLY ADJACENT TO THE OPTIC DISC
63
What is uveal effusion syndrome?
THIS IS A RARE AND BILATERAL ABNORMALITY OF THE CHOROID AND SCLERA
64
In what population is uveal effusion syndrome most common in?
IT IS MOST COMMONLY SEEN IN MIDDLE-AGED HYPERMETROPIC MALES AND IS ACCOAITED WITH NANOPTHALMOS (AXIAL LENGTH <20mm)
65
What are the features of uveal effusion syndrome?
MILD INFLAMMATION THICKENED SCLERA CILIOCHOROIDAL DETACHMENT EXUDATIVE RD RPE HYPERTROPHIC AREAS (LEOPARD SPOTS) IN CHRONIC CASES
66
How is uveal effusion syndrome managed?
FULL-THICKNESS SCLEROTOMIES
67
What is the epiretinal membrane?
THIS IS AN AVASCULAR FIBROCELLULAR SHEET OR MEMBRANE THAT DEVELOPS ON THE SURFACE OF THE RETINA
68
Who is the epiretinal membrane more common in?
females
69
What does the epiretinal membrane originate from?
PROLIFERATION OF RPE, GLIAL CELLS OR HYALOCYTES ON THE SURFACE OF THE RETINA CONTRACTURE ON THE RETINA LEADS TO PROBLEMS SUCH AS ELEVATION OF THE RETINA AND CMO
70
What are some synonyms for the appearance of the epiretinal membrane?
IN APPEARANCE: CELLOPHANE MACULOPATHY, MACULAR PUCKER
71
What are some synonyms for the appearance of pathogenesis of the epiretinal membrane?
PREMACULAR FIBORSIS IDIOPATHIC PREMACULA GLIOSIS
72
What are some causes of the epiretinal membrane?
IDIOPATHIC TRAUMA POSTERIOR UVEITIS BRVO IATROGENIC (CRYTHERAPHY, PHOTOCOAGULATION, RETINAL DETACHMEN SURGERY)
73
What are some features of the epiretinal membrane?
ASYMPTOMATIC METAMORPHOPSIA AND dVA CELLOPHANE MEMBRANE: MAY BE TRANSPARENT BEST SEEN WITH RED-FREE LIGHT MACULAR PUCKER: THICK CONTRACTED MEMBRANE WITH MILD DISTORTION OF BLOOD VESSELS OTHER FINDINGS: MACULAR PSEUDOHOLE, CMO, RETINAL HAEMORRHAGES AND TELANGIECTASIA
74
What investigations are used for epiretinal membrane?
OCT
75
How is the epiretinal membrane managed?
OBSERVATION: ONLY IF CONDITION IS STABLE VITRECTOMY
76
What is a macular hole
A FULL THICKNESS DEFECT IN THE FOVEA WITH SPLITTING OF ALL NEUROSENSORY RETINAL LAYERS FROM THE INTERNAL LIMITING MEMBRANE TO THE RPE
77
In what population is a macular hole most common?
FEMALES AGED 60-70
78
What are some causes of the macular hole?
PRIMARY: VITREOUS TRACTION ON THE FOVEA FROM A PVD (VITREOMACULAR TRACTION) SECONDARY: DOES NOT HAVE VITREOMACULAR TRACTION E.G. CASES CAUSED BY TRAUMA OR HIGH MYOPIA
79
What are some features of the macular hole?
METAMORPHOPSIA WITH CENTRA dVA
80
How is the macular hole classified?
USED TO BE CLASSIFIED BY THE GASS CLASSIFICATION BUT THIS HAS BEEN REPLACED BY THE OCT CLASSIFICATION
81
Describe the stages of classification for macular hole
VITREMACULAR ADHESION VITREOMACULAR TRACTION SMALL OR MEDIUM MACULAR HOLE WITH VMT MEDIUM OR LARGE MACULAR HOLE WITH VMT SMALL, MEDIUM OR LARGE MACULAR HOLE WITHOUT VMT
82
How are macuular holes managed?
USUALLY PATIENTS ARE oBSERVED IN STAGE 1 STAGE 2 MACULAR HOLES CAN BE MANAGED WITH EITHER VITRECTOMY OR INTRAVITREAL VITREOLYSIS WITH OCRIPLASMIN STAGES 3 AND 4 CAN BE MANAGED WITH VTRECTOMY, INTERNAL LIMITING MEMBRANE PEEL AND GAS TAMPONADE
83
What are hereditary vitreoretinal degenerations?
THESE ARE RARE CONGENITAL CONDITIONS CHARACTERISED BY EARLY RETINAL AND VITREAL DEGENERATION
84
What is x-linked retinoschisis?
DIFFERENT FROM DEGENERATIVE RETINOSCHISIS DUE TO INTRACELLULAR ADHESION ABNORMALITIES WHICH LEAD TO SPLITTING OF THE RETINA AT THE NERVE FIBRE LAYER
85
What are the features of x-linked retinoschisis?
TYPICALLY PRESENTES IN EARLY CHILDHOOD: HYPERMETROPIC BOYS PRESENT WITH READING DIFFICULTIES AT PRIMARY SCHOOL ON EXAMINATION: BILATERAL MACULOPATHY, FOVEAL SCHISIS WITH SPOKE-LIKE FOLDS WITH CYSTOID CHANGES RESEMBLING CMO WITHOUT LEAKAGE ON FA
86
What investigations are used for x-linked retinoschisis?
SCOTOPIC ERG (-ERG):NORMAL a WAVE, LOSS OF b WAVE WITH OSCILLATORY POTENTIALS
87
What is stickler syndrome?
MOST COMMON INHERITED CAUSE OF RD CONDITION IS AD AND OCCURS DUE TO DEFECT IN COLLAGE SYNTHESIS
88
Describe the features of stickler syndrome
OPTHALMIC: HIGH MYOPIA, CORTICAL CATARACTS, ECTOPIA LENTIS, GLAUCOMA, OPTICALLY EMPTY VITREOUS, RADIAL LATTICE-LIKE RETINAL DEGENERATION AND RRD SENSORINEURAL DEAFNESS PIERRE ROBIN FEATURES: MICROGNATHIA, GLOSSOPTOSIS, CLEFT PALATA, FLAT NASAL BRIDGE AND MAXILLARY HYPOPLASIA MARFANOID FEATURES
89
Describe the management of stickler syndrome
PROPHYLACTIC 360 RETINAL LASER VITRECTOMY IF RD OCCURS
90
What is wagner syndrome?
AD DISORDER SIMILAR TO STICKLER SYNDROME WITHOUT SYSTEMIC FEATURES
91
What are the features of wagner syndrome?
LOW MYOPIA CORTICAL CATARACTS OPTICALLY EMPTY VITREOUS
92
When is RD treated in wagner syndrome?
RD IS LINKED TO THIS CONDITION BUT IT LESS COMMON THAT IN STICKLER SYNDROME SO THEY ARE TREATED IF THEY OCCUR (I.E. NOT PROPHYLACTICALLY)

Duke Elder 2020 (9 decks)

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