Retina Review

Part 1

80 yo 20/100

83 yo male 20/200

AMD: Neovascular

• Define classic choroidal neovascularization– Early, bright uniform hyperfluorescence (within 30

seconds) exhibiting leakage in the late frames

72 yo 20/60 OD

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

63 yo c/o needs stronger reading glasses, 20/40

88 yo CF OD

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

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

47 yo recent distorted vision OS

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

50 yo male h/o pseudoxanthoma elasticum

Angioid Streaks

• What are systemic diseases associated with angioid streaks?– Pseudoxanthoma elasticum– Ehlers-Danlos syndrome– Paget’s disease of bone– Sickle cell disease– Idiopathic

50 yo long time contact lens wearer

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

33 yo business consultant, distortion OS, 20/25

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%

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

50 yo 20/50 OS

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%

60 yo 20/100

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

55 yo, 20/200(not from glx)

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%

70 yo 5 wk s/p CE with vit loss, 20/80

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%