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Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
Retina Review - Part 2
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Retina Review - Part 2

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  • Transcript

    • 1. Retina Review
      • Part 2
    • 2. 35 yo on multiple BP meds
    • 3.  
    • 4. 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
    • 5. 47 yo 20/20 referred by internist
    • 6. 62 yo diabetic 20/60
    • 7.  
    • 8. 33 yo diabetic 20/30 OU
    • 9.  
    • 10.  
    • 11.  
    • 12. 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
    • 13. Diabetic Retinopathy
      • ETDRS
        • Focal laser indicated for CSME
          • Retinal thickening at or within 500  m of the foveal center
          • Retinal thickening associated with hard exudate at or within 500  m 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
    • 14. 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%
    • 15. Diabetic Retinopathy
      • 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
    • 16. 35 yo African American male
    • 17.  
    • 18. 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: 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
    • 19. Baby
    • 20.  
    • 21. 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
    • 22. 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 on progression
    • 23. 71 yo woman h/o POAG 20/30
    • 24. 75 yo 20/80
    • 25. 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
    • 26. 60 yo Scotoma for one wk
    • 27.  
    • 28. 65 yo sudden decreased vision OU x 4hr
    • 29. 65 yo decreased vision x 3d
    • 30.  
    • 31. 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
    • 32. 82 yo NLP
    • 33.  
    • 34. 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
    • 35. 85yo chronic pain and redness OD
    • 36.  
    • 37. 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%)
    • 38. 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
    • 39. 35 yo asymptomatic
    • 40. 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
    • 41. 8 yo boy; parents noted leukocoria
    • 42.  
    • 43.  
    • 44. 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
    • 45. 40 yo 20/40 OU
    • 46.  
    • 47. Idiopathic Juxtafoveal Telangiectasis
      • What are the 3 clinical groups
        • Unilateral juxtafoveal telangiectasis
        • Bilateral juxtafoveal telangiectasis
        • Bilateral juxtafoveal telangiectasis with capillary obliteration
    • 48. 45 yo h/o HTN
    • 49.  
    • 50.  
    • 51. 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
    • 52. 50 yo c/o floater
    • 53. 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%
    • 54. 20 yo myope, asymptomatic
    • 55.  
    • 56.  
    • 57.  
    • 58. Lattice Degeneration
      • What is the prevalence of lattice degeneration in the general population?
        • 6-8%
      • Of patients with lattice, 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
    • 59. 60 yo c/o flashes
    • 60. 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
    • 61.  
    • 62.  
    • 63. 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 from the break
        • Subretinal fluid extends no more than 2DD posterior to the equator
    • 64. 60 yo asymptomatic
    • 65. Retinoschisis
      • What is the typical location in the fundus?
        • Inferotemporal
      • What layer is affected in typical retinoschisis?
        • 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
    • 66.  
    • 67.  
    • 68.  
    • 69.  
    • 70. 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
    • 71. 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
    • 72. 3 mo old term baby
    • 73.  
    • 74. 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

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