retina review - 1
TRANSCRIPT
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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 choroidalneovascularization – Fibrovascular PED: early stippled hyperfluorescence (within
first minute) exhibiting leakage or staining in the late frames
– Late leakage of undetermined etiology: late speckledhyperfluorescence 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 purelyoccult subfoveal lesions
• MARINA - Lucentis beneficial for minimally classic lesions
• ANCHOR - Lucentis beneficial for predominantly classiclesions
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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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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 fromprior episode
– Presence of permanent visual deficit in fellow
eye from prior episode
– Development of chronic signs (cystic change inretina; 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 20/50or 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 withsubretinal 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 <400mm
– III: full-thickness defect >400mm, 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 spontaneouslyresolve? – 95%