Vitreous/Retina/Uvea Flashcards by Ravi Patel

The vitreous attaches most firmly where?

Vitreous base - extends more posteriorly with advancing age.

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What is the primary vitreous?

Fibrillar material, meschymal cells, and vascular components: the hyaloid artery, vasa hyaloidea propria, and tunica vasculosa lentos.

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What is secondary vitreous?

Begins to form at the nineth week destine to become the MAIN portion of the vitreous in the adult eye.

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What is teritary vitreous?

zonular fibers

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Asteriod bodies stain with what and are made up of what?

Neutral fat, phospholipids, calcium; alcian blue, metachromatic and exhibit bifringence. Asteriod bodies can be surrounded by a foreign body giant cell.

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Where is the water shed area of the retina?

Inner nuclear layer

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What does retina blood supply?

Up to the inner 2/3 of the inner nuclear layer

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What does choroidal circulation supply?

Outer 1/3 of the inner nuclear layer

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What are the 8 functions of the RPE?

Vit A metabolism
Formation of the basal lamina of the inner portion of Bruch’s membrane
Production of the mucopolyscarride matrix that surrounds the photoreceptor outer segments

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In oculocutaneous albinism what is seen on histology?

Amount of melanin in each melanosome is reduced

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In ocular albinism what is seen on histology?

The number of mealosomes is reduced

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Mylinated NFL is a/w what?

Myopia
Amblyopia
Strabismus
Nystagmus

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Where is reticular peripheral cystoid degeneration found ?

NFL and more posterior to areas of TPCD - typical periphearl cystoid degeneration

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What are some histological characteristics for Lattice degeneration?

Discontinuity of the ILM
Sclerosed vessels that remain PATENT
Variable degrees of atrophy of the INNER layers of the retina.
RD as a result of vitreous adhesions at the MARGIN of LD

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In Pavingstone degeneration what do you see?

Inner nuclear layer is adherent to Bruch’s membrane b/c occlusion of the choriocapillaris can lead to loss of the outer retinal layers and RPE.

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What are cystoid bodies?

Localized accumulations of axoplasmic material that are present in ischemic infarcts of the NFL (ischemic damage to the nerve fibers of the ganglion cells)

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CWS take how long to resolve?

4-12 weeks.

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Henle’s layer is where?

Outer plexiform layer of the macula

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Chronic retinal ischemia leads to architectural changes in the retina. Adjacent to acellular capillaries, what forms?

Dilated irregular vascular channels = IRMA and microaneurysms often appear.

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What is a micro aneurysm histologically?

Hyalinized hypocelluar ma’s

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Carotid vascular dx forms what type of plaque?

Hollenhorst - cholesterol emboli

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Cardiac vascular dx causes what type of plaque?

calcific emboli

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Thromboembolism forms what type of plaque?

platelet-fibrin emboli

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What are histoloical changes seen in DR?

Thickening of the retinal capillary BM
SELECTIVE loss of pericytes compared with retinal capillary endothelial cells
CORNEAL epithelial BM is thickened.

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What histologically does NOT develop in ROP?

Retinal edema and exudates

What are the 5 AREDS vitamins?

1. Vit C 2. Vit E 3. Beta cartone 4. Zinc 5. Copper

Type 1 CNV is located where and a/w what?

Within Bruch's membrane in the sub-RPE space; more characteristic of AMD

Type 2 CNV is located where and a/w what?

Sub retinal and a/w ocular histoplasmosis

The ABCA4 gene is Stargardts codes what?

RIM protein which helps in ATPase binding.

What is the most common mutation a/w pattern dystrophies?

RDS/peripherin gene

What is the incidence of RP?

1/3500

What type of gene is the retinoblastoma gene?

TUMOR SUPPRESSOR GENE

What are histological findings of RB?

1. Tumor cells surrounding blood vessels 2. Zones of tumor necrosis 3. Calcium present in necrotic areas 4. Nuclei 2x the size of lymphocytes with amount no cytoplasm. 5. Flexner-Wintersteiner rosettes - expressions of retinal differentiation

What do Flexner-Wintersteiner rosettes look like?

Cells of rosettes surround a CENTRAL LUMEN lined by refractile structures. Refracticle lining corresponds to the EXTERNAL LIMITING MEMBRANE

In what 4 dx are Flexner-Wintersteiner rosettes seen in?

1. RB 2. Pinealoblastoma 3. Medulloepithelioma 4. Ectopic intracranial retinoblastoma

Where are Homer Wright rosettes seen in?

1. Neuroblastoma 2. Medulloblastoma 3. RB

What are Homer Wright rosettes and what does it look like?

NOT RETINAL differenitaion Filled with a tangle of eosinophilic cytoplasm (Homer Simpson likes jelly donuts - no hole)

What is a fleurette?

Photoreceptor differentiation seen in RB. Expresses a GREATER degree of retinal differentiation than does Flexner-Wintersteriner rosettes.

What spreads RB via the CNS?

Optic nerve invasion where cells spead into the leptomeninges

What spreads RB via hematogenous dissemination?

Massive uveal invasion.

How does a retinocytoma differ from RB histologically?

1. More cytoplasm and more evenly dispered nuclear chromatin. No mitoses 2. Calcification with NO necrosis

What does a medulloepithelimoa look like histologically?

Ribbon like structures with heteroplastic tissue - cartilage or smooth muscle

What is a Fuch's adenoma made of ?

Nonpigmented ciliary epithlium

What does the color of the iris depend on?

The number and size of the melanin pigment granules in STROMAL melanocytes.

In which dz is the choriocapillaris spared?

Sympathetic ophthalmia

What are Dalen-Fuchs nodules made of?

Collections of epithelioid hisitiocytes and lymphocytes between the RPE and Bruch's membrane

Where do most iris melanoma occur?

Inferior sectors of the iris - they follow a nonaggressive clinical course compared to posterior melanomas

What are the 3 types of uveal melanomas?

1. Spindle cell (Type A and B) 2. Epithelioid melanoma (worst prognosis) 3. Mixed- cell type

Where is there a propensity of uveal melanoma to metastasize ?

The LIVER

All choroidal melanocytic tumors thicker than WHAT are melanomas? And diameter?

3mm; 10mm

What are risk factors for a choroidal nevus to be malignant?

1. Orange pigmentation 2. Juxtapapillary location 3. hOMOGENEITY on ultrasound

What type of internal reflectivity does a chorodial melanoma have?

LOW

How do hemorrhagic detachments look?

Dome shaped, involving multiple quadrants and a/w breakthrough vitreous bleeding.

What type of internal reflectivity does a choroidal hemangioma have?

HIGH

What % of RB is b/l?

30-40%

If a parent has U/L RB and the first off spring is unaffected, what is the chance of the second child having RB?

7-15%

If you have an unaffected parent with a first with b/l dz what is the chance that the second child gets RB?

5% (if parent is a carrier then 45%)

A scan U/S measures what 3 things?

1. Internal reflectivity 2. Vascularity 3. Height

Vitreous amyloidosis is a/w what?

Peripheral neuropathy - both are a/w transthyretin abnormality

Touton giant cells are seen in what 3 d/o's?

1. Chalazion 2. Xanthogranuloma 3. Xanthelasma

Why do adult medulloepitheliomas occur?

Usually related to trauma that are actually reactive hyperplasia of the ciliary epithelium

Where does the sclera receive nutrition?

1. Choroid 2. Episcleral vessels. * It does not have its own capillary bed*

What portion of the sclera is dervied from the mesoderm?

Temporal (all other parts are from the NEURAL CREST cells!!!)

The RPE and neurosensory retina is derived from which cells?

Neuroectoderm

Schlems canal is dervied from what?

MESODERM

The Iris Stroma is derived from what cells?

Neural CREST (all other parts of the iris are dervied from the neuroectoderm)

The trabecular meshwork is dervied from where?

NEURAL CREST

The corneal stroma and endothelium is dervied from where?

NEURAL CREST

In NF1 what do you see histologically in the choroid?

hamartoumatous infiltrate with OVOID bodies (resembles tactile corpuscle)

What do astrocystic hamartomas look like on histology?

Calcospherites

In ataxia telengectasia which Ig is deficient?

IgA (increased incidence of lymphoma and increased alpha feta protein)

Blue argon laser absorbs what and does what to the retina?

Absorbs yellow macular pigment and DAMAGES the retina

Green argon laser absorbs what?

Melanin and BLOOD

In peripheral microcystoid degeneration what are the cyst filled with?

Hyaluronic acid

A pars plana cyst is what and filled with what?

Splitting between pigmented and non pigmented layers of the CILIARY epithelium and contain hylauronic acid

Gray sphere with a maltese cross makes you think of?

Asteriod hyalosis

Mutant protein TRANSTHYRETIN (pre albumin) causes what?

Amyloidosis in vitreous

What rarely mimic CNS lymphoma with b/l vitritis and dementia?

Whipples dx

Leiomyoma are found where and in whom?

Young girls, amelanotic tumors found in the supraciliary space

Where do enophytic RB arise?

From INNER retina and sees the vitreous

Where does an exophytic RB arise?

From the OUTER retina and causes RD.

Which dz invades the optic nerve: Uveal melanoma or RB?

In coats dz which part of the retina is usually affected?

Retinal dysplasia occurs with which trisomy usually?

What is the pathological hallmark of Bechets?

Vasculitis; chronic nongranulomatous uveitis

What is the most common ocular site for systemic sarcoid?

Uveal tract

In RB what the two main tumor seen not do to radiation tx?

1. Osteosarcoma | 2. Maligant melanoma

Where do cell bodies of Muller cells reside?

Inner nuclear layer

What happens with a CWS?

THICKENING of NFL with cystoid bodies - swollen axons blocked with axoplasm

Which dz has early trouble with acommondation and iris thickening?

Sympathetic ophthalmia

What are the 4 stages of VKH?

1. Prodromal stage (CSF pleocytosis, tinnitus, fever) 2. Acute Uveitic Stage (few days after stage 1) 3. Convalescent stage (several weeks after uveitic) - depigmentation of the choroid 4. Chronic recurrent stage - recurrent inflm, glaucoma, subretinal fibrosis, PSC

HLA-DR2?

Pars planitis (also DR51, DR17)

Amyloid makes what teriatary structure?

Beta pleated sheets

Which two metatstatic dz are a/w long survival times?

1. Breast CA | 2. Carcinoid tumors

What type of pattern do u see on FA with Choroidal melanomas?

Double circulation pattern - where both retinal and chorodial vessels are seen in the tumor.

Which is a more effective treatment for uveal melanoma: external beam radiation or charged particle radiation?

charged particle radiation

Vitreous/Retina/Uvea Flashcards

(96 cards)