Retina Review

Part 2

35 yo on multiple BP meds

Hypertensive Retinopathy • Describe fundus findings associated with hypertensive retinopathy? – – – – – – Constriction of retinal arterioles Intraretinal hemorrhages Cotton wool spots Macular edema Disc edema Retinal neovascularization • What are manifestations of hypertensive choroidopathy? – Elschnig spots and Siegrist streaks .

47 yo 20/20 referred by internist .

62 yo diabetic 20/60 .

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33 yo diabetic 20/30 OU .

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Diabetic Retinopathy • WESDR – IDDM 99% have retinopathy after 20 yr – NIDDM 60% have retinopathy after 20 yr • DCCT – Tight glucose control decreases retinopathy in IDDM • UKPDS – Glucose control decreases retinopathy in NIDDM .

Diabetic Retinopathy • ETDRS – Focal laser indicated for CSME • Retinal thickening at or within 500 mm of the foveal center • Retinal thickening associated with hard exudate at or within 500 mm of the foveal center • A zone of retinal thickening larger than 1 disc area within 1 disc diameter of the foveal center – PRP indicated for high risk PDR. not for NPDR (can consider for severe NPDR) – ASA does not affect vitreous hemorrhage .

Diabetic Retinopathy • Describe the 4:2:1 rule – 4 quadrants of diffuse intraretinal hemorrhage and microaneurysms – 2 quadrants of venous beading – 1 quadrant of intraretinal microvascular abnormalities • What is severe NPDR and what 1-year risk does it carry for progression to high-risk PDR? – 1 of the above criteria – 15% • What is very severe NPDR and what 1-year risk does it carry for progression to high-risk PDR? – 2 of the above criteria – 45% .

PRP reduces severe visual loss by 50% for high risk PDR – Mild (1/4 to 1/3 disc area) NVD with vitreous hemorrhage – Moderate to severe NVD with or w/o vitreous hemorrhage – Moderate (1/2 disc area) NVE with vitreous hemorrhage • DRVS .Diabetic Retinopathy • DRS .vitrectomy for nonclearing vitreous hemorrhage – Early vitrectomy beneficial for IDDM – Early (1 mo) same as late (6 mo) for NIDDM • Other indications for surgery – Macula involving TRD – Combined TRD/RRD – Refractory macular edema with taut posterior hyaloid .

35 yo African American male .

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Sickle Cell Retinopathy • Which form of sickle cell is associated with the most serious ocular complications? – Hb SC • What are the findings on nonproliferative sickle cell retinopathy? – Salmon patch hemorrhage (intraretinal hemorrhage) – Refractile spot (resorbed hemorrhage) – Black sunburst (RPE hypertrophy) • What are the stages of proliferative sickle cell retinopathy? – – – – – I: II: III: IV: V: arteriolar occlusions arteriovenous anastomoses sea-fan neovascularization vitreous hemorrhage tractional retinal detachment • What is the preferred treatment for PSR? – Peripheral scatter photocoagulation – Vitrectomy for non-clearing vitreous hemorrhage or RD .

Baby .

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ROP • Describe the stages of ROP – – – – 1: 2: 3: 4: • • – 5: demarcation line elevated ridge ridge with extraretinal fibrovascular proliferation subtotal retinal detachment A extrafoveal B involving fovea total retinal detachment • Define plus disease – Retinal vascular dilation and tortuosity in the posterior pole .

oxygen level had no effect on progression .ROP • Define threshold ROP – Zone I or II – Extent of 5 contiguous or 8 non-contiguous clock hours of extraretinal neovascularization – Plus disease – Threshold benefits from cryo or laser • STOP-ROP .

71 yo woman h/o POAG 20/30 .

75 yo 20/80 .

disc. NVG – Prophylactic laser not recommended – Laser once NV (iris. retina) develops .BVOS and CVOS • Grid laser for macular edema – Beneficial for BRVO – Not beneficial for CRVO • PRP laser for prevention of VH.

60 yo Scotoma for one wk .

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65 yo sudden decreased vision OU x 4hr .

65 yo decreased vision x 3d .

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Central Retinal Artery Occlusion • What percentage of eyes have vision <20/400? – 66% • With NLP vision. what diagnosis must be considered? – Ophthalmic artery occlusion • What is the leading cause of death in patients with CRAO? – Cardiovascular disease .

82 yo NLP .

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Central Retinal Artery Occlusion
• What percentage of CRAO is accounted for by giant cell arteritis?
– 1-2%

• What are some methods used as therapy for CRAO?
– Ocular massage – Anterior chamber paracentesis – Administration of carbogen

85yo chronic pain and redness OD

Ocular Ischemic Syndrome • What percent carotid obstruction is typically required to cause OIS? – 90% • Describe the symptoms – Gradual visual loss – Aching pain – Prolonged recovery following bright light exposure • What are anterior segment findings? – Iris neovascularization (67%) – AC cellular reaction (20%) .

microaneurysms Neovascularization • What are the fluorescein angiographic findings? – Delayed choroidal filling (60%) – Delayed arteriovenous transit (95%) – Vascular staining (85%) • What is the 5-year mortality rate and what is the most common cause of death? – 40% – Cardiovascular disease . non-tortuous veins Mid-peripheral retinal hemorrhages.Ocular Ischemic Syndrome • Describe the posterior segment findings – – – – Narrowed arteries Dilated.

35 yo asymptomatic .

Retinal Vasculitis • What is the differential diagnosis of retinal vasculitis? – – – – – – Giant cell arteritis Sarcoidosis Behcets disease Lupus Polyarteritis Inflammatory Bowel Dz Multiple sclerosis Syphilis Pars planitis Toxoplasmosis Idiopathic .

8 yo boy. parents noted leukocoria .

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Coats Disease • Describe the clinical findings – – – – Telangiectatic vessels. microaneurysms Fusiform capillary dilation Exudative retinal detachment Capillary non-perfusion • What is the mode of transmission? – Not hereditary • What is the percentage of cases affecting males? – 85% • What treatments are employed to halt progression? – Cryotherapy or photocoagulation – Retinal reattachment surgery .

40 yo 20/40 OU .

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Idiopathic Juxtafoveal Telangiectasis • What are the 3 clinical groups – Unilateral juxtafoveal telangiectasis – Bilateral juxtafoveal telangiectasis – Bilateral juxtafoveal telangiectasis with capillary obliteration .

45 yo h/o HTN .

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or subretinal hemorrhage – Vitreous hemorrhage – Macular edema/exudation .Retinal Arterial Macroaneurysm • What percentage of cases are associated with systemic hypertension? – 67% • What are causes of visual loss? – Intra.

50 yo c/o floater .

Posterior Vitreous Detachment • What percentage of patients with acute symptomatic PVD have a retinal tear? – 15% • What percentage of patients with vitreous hemorrhage associated with PVD have a retinal tear? – 70% .

20 yo myope. asymptomatic .

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what is chance of RD? – 1% • What percentage of retinal detachments have associated lattice degeneration? – 20-30% • Describe the histopathologic features – – – – Discontinuity of the ILM Overlying pocket of liquefied vitreous Adherence of vitreous at the margin Atrophy of inner retinal layers .Lattice Degeneration • What is the prevalence of lattice degeneration in the general population? – 6-8% • Of patients with lattice.

60 yo c/o flashes .

07% • What types of retinal breaks should be treated? – Symptomatic horseshoe tears – Retinal dialysis .Retinal Breaks • What percentage of the population will develop a retinal detachment over their lifetime? – 0.

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87% ≥ 20/50 – Mac off .Retinal Detachment • What is optimal timing for surgery? – Mac on .30-50% ≥ 20/50 • < 1 wk 75% ≥ 20/70 • 1-8 wk 50% ≥ 20/70 • Define subclinical retinal detachment – Subretinal fluid extends more than 1DD from the break – Subretinal fluid extends no more than 2DD posterior to the equator .

60 yo asymptomatic .

juvenile retinoschisis in NFL) • How can schisis be differentiated from RD? – – – – Absolute scotoma No associated tear/tobacco dust Smoother surface Laser scars .Retinoschisis • What is the typical location in the fundus? – Inferotemporal • What layer is affected in typical retinoschisis? – Outer plexiform – (reticular retinoschsis.

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strabismus. cataract • Which of the above conditions is associated with retinal detachment? – Jansen disease .Hereditary Hyaloidoretinopathies • Describe features of Jansen and Wagner disease – – – – Autosomal dominant transmission Optically empty vitreous Equatorial and perivascular lattice Myopia.

glaucoma. giant retinal tear. glossoptosis) – Skeletal abnormalities • Joint hyperextensibility • Arthritis • Spondyloepiphyseal dysplasia – High incidence of RD. cleft palate. cataract – Orofacial findings • Midfacial flattening • Pierre-Robin malformation (micrognathia. PVR .Stickler Syndrome • Describe the features of Stickler Syndrome – Autosomal dominant transmission – Myopia.

3 mo old term baby .

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FEVR • What is the mode of inheritance of familial exudative vitreoretinopathy? – Autosomal dominant • Describe the clinical features – – – – – – Normal birth weight/gestational age Failure of the temporal retina to completely vascularize Peripheral fibrovascular proliferation Traction retinal detachment Subretinal exudate or exudative detachment Late-onset rhegmatogenous detachment .