Retina - 2

7/28/2019 Retina - 2

http://slidepdf.com/reader/full/retina-2 1/74

Retina Review

Part 2

http://localhost/var/www/apps/conversion/tmp/Macular/I1.PPT

http://localhost/var/www/apps/conversion/tmp/V/V1.PPT

http://localhost/var/www/apps/conversion/tmp/III/III1.PPT

http://localhost/var/www/apps/conversion/tmp/VI/VI1.PPT

http://localhost/var/www/apps/conversion/tmp/IV/IV1.PPT

http://localhost/var/www/apps/conversion/tmp/II/II1.PPT

http://localhost/var/www/apps/conversion/tmp/VII/VII1.PPT


7/28/2019 Retina - 2


35 yo on multiple BP meds









7/28/2019 Retina - 2










7/28/2019 Retina - 2


Hypertensive Retinopathy

• Describe fundus findings associated withhypertensive retinopathy? – Constriction of retinal arterioles

– Intraretinal hemorrhages

– Cotton wool spots

– Macular edema

– Disc edema

– Retinal neovascularization

• What are manifestations of hypertensivechoroidopathy?

– Elschnig spots and Siegrist streaks









7/28/2019 Retina - 2


47 yo 20/20 referred by internist









7/28/2019 Retina - 2


62 yo diabetic

20/60









7/28/2019 Retina - 2










7/28/2019 Retina - 2


33 yo diabetic 20/30 OU









7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2


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









7/28/2019 Retina - 2



• 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









7/28/2019 Retina - 2



• 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%









7/28/2019 Retina - 2



• DRS - 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 - 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









7/28/2019 Retina - 2


35 yo African American male









7/28/2019 Retina - 2










7/28/2019 Retina - 2


Sickle Cell Retinopathy

• Which form of sickle cell is associated with the mostserious ocular complications?

– Hb SC

• What are the findings on nonproliferative sickle cellretinopathy?

– Salmon patch hemorrhage (intraretinal hemorrhage)

– Refractile spot (resorbed hemorrhage) – Black sunburst (RPE hypertrophy)

• What are the stages of proliferative sickle cell retinopathy?

– I: arteriolar occlusions

– II: arteriovenous anastomoses

– III: sea-fan neovascularization – IV: vitreous hemorrhage

– V: tractional retinal detachment

• What is the preferred treatment for PSR?

– Peripheral scatter photocoagulation

–Vitrectomy for non-clearing vitreous hemorrhage or RD









7/28/2019 Retina - 2


Baby









7/28/2019 Retina - 2


7/28/2019 Retina - 2


ROP

• Describe the stages of ROP

– 1: demarcation line

– 2: elevated ridge

– 3: ridge with extraretinal fibrovascular proliferation

– 4: subtotal retinal detachment

• A extrafoveal

• B involving fovea

– 5: total retinal detachment

• Define plus disease – Retinal vascular dilation and tortuosity in the posterior pole









7/28/2019 Retina - 2


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 - oxygen level had no effect onprogression









7/28/2019 Retina - 2


71 yo woman h/o POAG

20/30









7/28/2019 Retina - 2


75 yo 20/80









7/28/2019 Retina - 2


BVOS and CVOS

• Grid laser for macular edema

– Beneficial for BRVO

– Not beneficial for CRVO

• PRP laser for prevention of VH, NVG

– Prophylactic laser not recommended

– Laser once NV (iris, disc, retina) develops









7/28/2019 Retina - 2


60 yo

Scotoma for

one wk









7/28/2019 Retina - 2












7/28/2019 Retina - 2


65 yo sudden decreased vision OU x 4hr











7/28/2019 Retina - 2


65 yo decreased vision x 3d











7/28/2019 Retina - 2













7/28/2019 Retina - 2


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












7/28/2019 Retina - 2


82 yo NLP












7/28/2019 Retina - 2













7/28/2019 Retina - 2


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












7/28/2019 Retina - 2


85yo chronic pain and redness OD









7/28/2019 Retina - 2





7/28/2019 Retina - 2


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%)












7/28/2019 Retina - 2


Ocular Ischemic Syndrome

• Describe the posterior segment findings – Narrowed arteries

– Dilated, non-tortuous veins

– Mid-peripheral retinal hemorrhages, 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












7/28/2019 Retina - 2


35 yo asymptomatic












7/28/2019 Retina - 2


Retinal Vasculitis

• What is the differential diagnosis of retinal

vasculitis?

– Giant cell arteritis Multiple sclerosis

– Sarcoidosis Syphilis

– Behcets disease Pars planitis

– Lupus Toxoplasmosis

– Polyarteritis Idiopathic

– Inflammatory Bowel Dz












7/28/2019 Retina - 2


8 yo boy; parents noted leukocoria












7/28/2019 Retina - 2













7/28/2019 Retina - 2













7/28/2019 Retina - 2


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












7/28/2019 Retina - 2


40 yo 20/40 OU












7/28/2019 Retina - 2













7/28/2019 Retina - 2


Idiopathic Juxtafoveal Telangiectasis

• What are the 3 clinical groups

– Unilateral juxtafoveal telangiectasis

– Bilateral juxtafoveal telangiectasis

– Bilateral juxtafoveal telangiectasis with capillary

obliteration












7/28/2019 Retina - 2


45 yo h/o HTN












7/28/2019 Retina - 2













7/28/2019 Retina - 2










7/28/2019 Retina - 2


Retinal Arterial Macroaneurysm

• What percentage of cases are associated with

systemic hypertension?

– 67%

• What are causes of visual loss?

– Intra- or subretinal hemorrhage

– Vitreous hemorrhage

– Macular edema/exudation









7/28/2019 Retina - 2


50 yo c/o floater









7/28/2019 Retina - 2


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 t ti









7/28/2019 Retina - 2


20 yo myope, asymptomatic









7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2







7/28/2019 Retina - 2


60 yo c/o flashes




7/28/2019 Retina - 2


60 yo c/o flashes









7/28/2019 Retina - 2


Retinal Breaks

• What percentage of the population will

develop a retinal detachment over their

lifetime?

– 0.07%

• What types of retinal breaks should be

treated?

– Symptomatic horseshoe tears

– Retinal dialysis









7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2


Retinal Detachment

• What is optimal timing for surgery? – Mac on - 87% ≥ 20/50

– Mac off - 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 fromthe break

– Subretinal fluid extends no more than 2DDposterior to the equator

60 yo asymptomatic









7/28/2019 Retina - 2


60 yo asymptomatic

Retinoschisis









7/28/2019 Retina - 2


Retinoschisis

• What is the typical location in the fundus?

– Inferotemporal

• What layer is affected in typicalretinoschisis? – Outer plexiform

– (reticular retinoschsis, juvenile retinoschisis in NFL)

• How can schisis be differentiated from

RD? – Absolute scotoma

– No associated tear/tobacco dust

– Smoother surface

– Laser scars









7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2










7/28/2019 Retina - 2


Hereditary Hyaloidoretinopathies









7/28/2019 Retina - 2


Hereditary Hyaloidoretinopathies

• Describe features of Jansen and Wagner

disease – Autosomal dominant transmission

– Optically empty vitreous

– Equatorial and perivascular lattice

– Myopia, strabismus, cataract

• Which of the above conditions is

associated with retinal detachment? – Jansen disease

Stickler Syndrome









7/28/2019 Retina - 2


Stickler Syndrome

• Describe the features of Stickler

Syndrome – Autosomal dominant transmission

– Myopia, glaucoma, cataract

– Orofacial findings

• Midfacial flattening• Pierre-Robin malformation (micrognathia,

cleft palate, glossoptosis)

– Skeletal abnormalities

• Joint hyperextensibility• Arthritis

• Spondyloepiphyseal dysplasia

– High incidence of RD, giant retinal tear, PVR









7/28/2019 Retina - 2


3 mo old term baby









7/28/2019 Retina - 2


FEVR









7/28/2019 Retina - 2


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






Documents

Retina - 2