Download - Retina Review - Part 1
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Retina Review
Part 1
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80 yo 20/100
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83 yo male 20/200
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AMD: Neovascular
• Define classic choroidal neovascularization– Early, bright uniform hyperfluorescence (within 30
seconds) exhibiting leakage in the late frames
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72 yo 20/60 OD
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AMD: Neovascular
• Define the two types of occult choroidal neovascularization– Fibrovascular PED: early stippled hyperfluorescence (within
first minute) exhibiting leakage or staining in the late frames– Late leakage of undetermined etiology: late speckled
hyperfluorescence with no corresponding source in the early frames
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63 yo c/o needs stronger reading glasses, 20/40
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88 yo CF OD
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AMD: Prevention
• Summarize results of the AREDS Study
– Beneficial subgroups:• Intermediate AMD in both eyes or advanced AMD
in one eye– 5-year risk of progression to advanced AMD:
• Placebo: 28%• Antioxidants + Zinc: 20%
– Formulation:• Vitamin C 500mg• Vitamin E 400IU• Beta carotene 15mg• Zinc 80mg
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AMD: Treatment
• MPS Study - Thermal laser beneficial for extrafoveal and juxtafoveal classic lesions
• TAP Study - PDT beneficial for classic subfoveal lesions
• VIP Study - PDT slightly beneficial at 2 years for purely occult subfoveal lesions
• MARINA - Lucentis beneficial for minimally classic lesions
• ANCHOR - Lucentis beneficial for predominantly classic lesions
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47 yo recent distorted vision OS
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OHS
• Describe the clinical triad of OHS.– Punched out chorioretinal lesions (histo spots)– Peripapillary atrophy– Choroidal neovascularization
• What is the endemic geographic region?– Mississipi and Ohio River Valley
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50 yo male h/o pseudoxanthoma elasticum
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Angioid Streaks
• What are systemic diseases associated with angioid streaks?– Pseudoxanthoma elasticum– Ehlers-Danlos syndrome– Paget’s disease of bone– Sickle cell disease– Idiopathic
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50 yo long time contact lens wearer
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Pathologic Myopia• What is the commonly accepted definition based
on axial length and refractive status?– Axial length > 26mm– Spherical equivalent < -8.00D
• What is the spectrum of fundus findings?– Lacquer cracks– Subretinal hemorrhage– Fuchs’ spot– Posterior staphyloma– RPE/choroidal atrophy– Cystoid, paving-stone, lattice degeneration– Retinal thinning/holes– Scleral thinning– CNV
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33 yo business consultant, distortion OS, 20/25
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CSC• How is the characteristic patient described?
– Healthy male, 30-50 yo, type-A personality
• What is the most common angiographic finding?– Small, focal hyperfluorescent RPE leak
• How frequently does a ‘smokestack’ occur? – 10%
• What is the rate of spontaneous resolution of subretinal fluid?– 80-90%
• What is the recurrence rate?– 40-50%
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CSC
• What are indications for laser photocoagulation?– Persistence of serous detachment >3-4mo– Recurrence in eyes with visual deficit from prior
episode– Presence of permanent visual deficit in fellow
eye from prior episode– Development of chronic signs (cystic change in
retina; widespread RPE abnormalities)– Occupational need
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50 yo 20/50 OS
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Epiretinal Membrane• What are the clinical findings?
– Metamorphopsia & decreased acuity– Retinal striae– Subretinal fluid or cystic change– Almost always associated with PVD
• What is the incidence of bilaterality? – 20%
• What percentage of eyes maintain vision 20/50 or better? – 75%
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60 yo 20/100
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VMT
• What are the clinical findings?– Metamorphopsia and decreased vision– Partial posterior vitreous detachment– Vitreous traction on the macula with
subretinal fluid accumulation or CME
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55 yo, 20/200(not from glx)
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Macular Hole
• Describe the 4 stages of macular hole– Ia: foveolar detachment– II: full-thickness defect <400m– III: full-thickness defect >400m, no PVD– IV: stage III with PVD
• What is the incidence of bilaterality? – 10-20%
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70 yo 5 wk s/p CE with vit loss, 20/80
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CME
• In what histologic layer does fluid collect?– Outer plexiform
• What are common causes?– Postoperative– Uveitis– Retinal venous occlusive disease– Choroidal neovascularization– Epiretinal membrane/VMT– Retinitis pigmentosa
• What is the incidence of clinical CME following extracapsular CE with intact capsule? – <1%
• What percentage of cases spontaneously resolve? – 95%