Retina Review - Part 1

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Retina Review - Part 1

  1. 1. Retina Review <ul><li>Part 1 </li></ul>
  2. 2. 80 yo 20/100
  3. 4. 83 yo male 20/200
  4. 5. AMD: Neovascular <ul><li>Define classic choroidal neovascularization </li></ul><ul><ul><li>Early, bright uniform hyperfluorescence (within 30 seconds) exhibiting leakage in the late frames </li></ul></ul>
  5. 6. 72 yo 20/60 OD
  6. 7. AMD: Neovascular <ul><li>Define the two types of occult choroidal neovascularization </li></ul><ul><ul><li>Fibrovascular PED: early stippled hyperfluorescence (within first minute) exhibiting leakage or staining in the late frames </li></ul></ul><ul><ul><li>Late leakage of undetermined etiology: late speckled hyperfluorescence with no corresponding source in the early frames </li></ul></ul>
  7. 8. 63 yo c/o needs stronger reading glasses, 20/40
  8. 10. 88 yo CF OD
  9. 11. AMD: Prevention <ul><li>Summarize results of the AREDS Study </li></ul><ul><ul><li>Beneficial subgroups: </li></ul></ul><ul><ul><ul><li>Intermediate AMD in both eyes or advanced AMD in one eye </li></ul></ul></ul><ul><ul><li>5-year risk of progression to advanced AMD: </li></ul></ul><ul><ul><ul><li>Placebo: 28% </li></ul></ul></ul><ul><ul><ul><li>Antioxidants + Zinc: 20% </li></ul></ul></ul><ul><ul><li>Formulation: </li></ul></ul><ul><ul><ul><li>Vitamin C 500mg </li></ul></ul></ul><ul><ul><ul><li>Vitamin E 400IU </li></ul></ul></ul><ul><ul><ul><li>Beta carotene 15mg </li></ul></ul></ul><ul><ul><ul><li>Zinc 80mg </li></ul></ul></ul>
  10. 12. AMD: Treatment <ul><li>MPS Study - Thermal laser beneficial for extrafoveal and juxtafoveal classic lesions </li></ul><ul><li>TAP Study - PDT beneficial for classic subfoveal lesions </li></ul><ul><li>VIP Study - PDT slightly beneficial at 2 years for purely occult subfoveal lesions </li></ul><ul><li>M ARINA - Lucentis beneficial for m inimally classic lesions </li></ul><ul><li>AN C HOR - Lucentis beneficial for predominantly c lassic lesions </li></ul>
  11. 13. 47 yo recent distorted vision OS
  12. 15. OHS <ul><li>Describe the clinical triad of OHS. </li></ul><ul><ul><li>Punched out chorioretinal lesions (histo spots) </li></ul></ul><ul><ul><li>Peripapillary atrophy </li></ul></ul><ul><ul><li>Choroidal neovascularization </li></ul></ul><ul><li>What is the endemic geographic region? </li></ul><ul><ul><li>Mississipi and Ohio River Valley </li></ul></ul>
  13. 16. 50 yo male h/o pseudoxanthoma elasticum
  14. 20. Angioid Streaks <ul><li>What are systemic diseases associated with angioid streaks? </li></ul><ul><ul><li>P seudoxanthoma elasticum </li></ul></ul><ul><ul><li>E hlers-Danlos syndrome </li></ul></ul><ul><ul><li>P aget’s disease of bone </li></ul></ul><ul><ul><li>S ickle cell disease </li></ul></ul><ul><ul><li>I diopathic </li></ul></ul>
  15. 21. 50 yo long time contact lens wearer
  16. 23. Pathologic Myopia <ul><li>What is the commonly accepted definition based on axial length and refractive status? </li></ul><ul><ul><li>Axial length > 26mm </li></ul></ul><ul><ul><li>Spherical equivalent < -8.00D </li></ul></ul><ul><li>What is the spectrum of fundus findings? </li></ul><ul><ul><li>Lacquer cracks </li></ul></ul><ul><ul><li>Subretinal hemorrhage </li></ul></ul><ul><ul><li>Fuchs’ spot </li></ul></ul><ul><ul><li>Posterior staphyloma </li></ul></ul><ul><ul><li>RPE/choroidal atrophy </li></ul></ul><ul><ul><li>Cystoid, paving-stone, lattice degeneration </li></ul></ul><ul><ul><li>Retinal thinning/holes </li></ul></ul><ul><ul><li>Scleral thinning </li></ul></ul><ul><ul><li>CNV </li></ul></ul>
  17. 24. 33 yo business consultant, distortion OS, 20/25
  18. 30. CSC <ul><li>How is the characteristic patient described? </li></ul><ul><ul><li>Healthy male, 30-50 yo, type-A personality </li></ul></ul><ul><li>What is the most common angiographic finding? </li></ul><ul><ul><li>Small, focal hyperfluorescent RPE leak </li></ul></ul><ul><li>How frequently does a ‘smokestack’ occur? </li></ul><ul><ul><li>10% </li></ul></ul><ul><li>What is the rate of spontaneous resolution of subretinal fluid? </li></ul><ul><ul><li>80-90% </li></ul></ul><ul><li>What is the recurrence rate? </li></ul><ul><ul><li>40-50% </li></ul></ul>
  19. 31. CSC <ul><li>What are indications for laser photocoagulation? </li></ul><ul><ul><li>Persistence of serous detachment >3-4mo </li></ul></ul><ul><ul><li>Recurrence in eyes with visual deficit from prior episode </li></ul></ul><ul><ul><li>Presence of permanent visual deficit in fellow eye from prior episode </li></ul></ul><ul><ul><li>Development of chronic signs (cystic change in retina; widespread RPE abnormalities) </li></ul></ul><ul><ul><li>Occupational need </li></ul></ul>
  20. 32. 50 yo 20/50 OS
  21. 34. Epiretinal Membrane <ul><li>What are the clinical findings? </li></ul><ul><ul><li>Metamorphopsia & decreased acuity </li></ul></ul><ul><ul><li>Retinal striae </li></ul></ul><ul><ul><li>Subretinal fluid or cystic change </li></ul></ul><ul><ul><li>Almost always associated with PVD </li></ul></ul><ul><li>What is the incidence of bilaterality? </li></ul><ul><ul><li>20% </li></ul></ul><ul><li>What percentage of eyes maintain vision 20/50 or better? </li></ul><ul><ul><li>75% </li></ul></ul>
  22. 35. 60 yo 20/100
  23. 36. VMT <ul><li>What are the clinical findings? </li></ul><ul><ul><li>Metamorphopsia and decreased vision </li></ul></ul><ul><ul><li>Partial posterior vitreous detachment </li></ul></ul><ul><ul><li>Vitreous traction on the macula with subretinal fluid accumulation or CME </li></ul></ul>
  24. 37. 55 yo, 20/200 (not from glx)
  25. 39. Macular Hole <ul><li>Describe the 4 stages of macular hole </li></ul><ul><ul><li>Ia: foveolar detachment </li></ul></ul><ul><ul><li>II: full-thickness defect <400  m </li></ul></ul><ul><ul><li>III: full-thickness defect > 400  m, no PVD </li></ul></ul><ul><ul><li>IV: stage III with PVD </li></ul></ul><ul><li>What is the incidence of bilaterality? </li></ul><ul><ul><li>10-20% </li></ul></ul>
  26. 40. 70 yo 5 wk s/p CE with vit loss, 20/80
  27. 41. CME <ul><li>In what histologic layer does fluid collect? </li></ul><ul><ul><li>Outer plexiform </li></ul></ul><ul><li>What are common causes? </li></ul><ul><ul><li>Postoperative </li></ul></ul><ul><ul><li>Uveitis </li></ul></ul><ul><ul><li>Retinal venous occlusive disease </li></ul></ul><ul><ul><li>Choroidal neovascularization </li></ul></ul><ul><ul><li>Epiretinal membrane/VMT </li></ul></ul><ul><ul><li>Retinitis pigmentosa </li></ul></ul><ul><li>What is the incidence of clinical CME following extracapsular CE with intact capsule? </li></ul><ul><ul><li><1% </li></ul></ul><ul><li>What percentage of cases spontaneously resolve? </li></ul><ul><ul><li>95% </li></ul></ul>

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