Retina Review - 1

7/28/2019 Retina Review - 1

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Retina Review

Part 1

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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 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











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 purelyoccult subfoveal lesions

• MARINA - Lucentis beneficial for minimally classic lesions

• ANCHOR - Lucentis beneficial for predominantly classiclesions











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















































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 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














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 20/50or 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 withsubretinal 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 <400mm

– III: full-thickness defect >400mm, 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 spontaneouslyresolve? – 95%









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Retina Review - 1