This document summarizes several common retinal conditions including retinal detachment, central retinal artery occlusion, branch retinal artery occlusion, hypertensive retinopathy, central retinal vein obstruction, branch retinal vein obstruction, diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, papilledema, optic neuritis, and optic atrophy. For each condition, it describes the clinical features and treatments. It also discusses intravitreal injections including common indications, medications used, and the preferred injection site.

1. COMMON RETINA
CONDITIONS
DR. AJAY DUDANI,
MUMBAI RETINA CENTRE,
SANTA CRUZ, MUMBAI.

2. RETINAL DETACHMENT
Separation of the neural retina from the underlying retinal
pigment epithelium.
• Types: Rhegmatogenous.
Tractional.
Exudative.

3. REGHMATOGENOUS RD

4. TREATMENT
• Vitrectomy with
silicon oil.
• Band buckling
surgery.

5. CENTRAL RETINAL ARTERY
OCCLUSION
An abrupt diminution
of blood flow through
the central retinal
artery serve enough to
cause ischemia of the
inner retina.

6. FFA

7. CLINICAL FEATURES
• Abrupt, painless, severe loss of vision.
• Cherry-red spot.
• Box-carring of blood flow in the retinal vessels.
• Ischemic retinal whitening of the posterior pole.

8. TREATMENT
• Carbogen Inhalation (95% Oxygen + 5% CO2)
• Ocular massage, paracentesis and administration of
ocular hypertensive medications
• Anti coagulants and fibrinolytic medications

9. BRANCH RETINAL ARTERY
OCCLUSION
An abrupt diminution of
blood flow through a
branch of central retinal
artery severe enough to
cause ischemia of inner
retina in the territory of
the affected vessel.

10. FFA

11. CLINICAL FEATURES
• Retinal whitening in the territory of the obstructed vessel.
• Embolus(66%)
• Visual field defect that correspond to the territory of the
obstructed vessels.

12. TREATMENT
• Ocular massage, paracentesis and administration of
ocular hypertensive medications
• Laser Photocoagulation to melt embolus

13. HYPERTENSIVE RETINOPATHY
Retinal vascular changes occurring from chronically
elevated systemic arterial hypertension.

14. HYPERTENSIVE
RETINOPATHY

15. CLINICAL FEATURES
• Narrowing and irregularity of retinal arteries.
• Arteriovenous nicking (narrowing of retinal veins at
arteriovenous crossing sites.)
• Blot retinal haemorrhages.
• Microaneurysms.
• Cotton-wool spots.

16. TREATMENT
• Treatment of Underlying Systemic condition can halt the
progress of retinal condition

17. CENTRAL RETINAL VEIN
OBSTRUCTION
Obstruction of the
central retinal vein at
the lamina cribrosa.

18. CLINICAL FEATURES
• Retinal haemorrhages in all four quadrants.
• Dilated, tortuous veins in all four quadrants.
• Optic disc oedema.
• Macular oedema.
• Cotton wool spots.
• Neovascularisation of the iris, retina or optic disc.

19. BRANCH RETINAL VEIN
OBSTRUCTION
Obstruction of branch
retinal vein.

20. FFA

21. CLINICAL FEATURES
• Retinal haemorrhages in the distribution of the obstructed
branch retinal vein.

22. TREATMENT
• Intravitreal Anti VEGF
• Intravitreal Steroid
• Grid Photocoagulation

23. DIABETIC RETINOPATHY
Progressive dysfunction of the retinal vasculature caused by
chronic hyperglycemia.

24. DIABETIC RETINOPATHY
NPDR PDR

25. CLINICAL FEATURES
• Microaneurysm.
• Retinal haemorrhages.
• Cotton wool spots.
• Macular oedema.
• Neovascularization.

26. TREATMENT
• Anti VEGF
• Panretinal Photocoagulation
• Peripheral retinal cryotherapy
• Vitrectomy in diabetic patients

27. TREATMENT
PRP VITRECTOMY

28. AGE RELATED MACULAR
DEGENERATION
• Age-related macular degeneration (AMD) is the leading
cause of irreversible severe visual loss in patients over 50
years of age.
• Types: Non exudative AMD
Exudative AMD

29. WET AMD DRY AMD

30. FFA
WET AMD DRY AMD

31. TREATMENT
• Intravitreal anti-VEGF
• Photodynamic Therapy
• Transpupillary thermotherapy
• Double frequency Nd YAG
• Surgery

32. RETINITIS PIGMENTOSA
• The term Retinitis pigmentosa encompasses a set of
diverse hereditary disorders that affect the photoreceptors
and retinal pigment epithelium.

33. RETINITIS PIGMENTOSA

34. CLINICAL FEATURES
• Progressive photoreceptor dysfunction and death.
• Intraneural retinal “bone spicule” pigment.
• Gliotic “waxy pallor” of optic nerve head.
• Visual field constriction.
• Night blindness.
• Loss of rod and cone electroretinography responses.

35. • Frequently, but not always, a family history.

36. PAPILLOEDEMA
Optic disc oedema
usually bilateral that
results from increased
intracranial pressure

37. CLINICAL FEATURES
• Blurring of optic disc margins
• Hyperaemia of optic nerve head
• Venous Congestion of arcuate and peri-papillary vessels.
• Engorged and dusty veins
• Peri-papillary splinter haemorrhages

38. TREATMENT
• Repeated lumbar puncture
• Diuretics
• Carbonic anhydrase inhibitors
• Optic nerve Sheath decompression
• Lumbar peritoneal Shunt

39. OPTIC NEURITIS
• It refers to inflammation of the optic nerve.
• Such inflammation my spare the optic disc (Retrobulbar
Optic neuritis) or may cause optic disc swelling(papillitis)

40. CLINICAL FEATURES
• Abrupt Vision loss.
• Dyschromatopsia.
• Afferent pupillary defect.

41. TREATMENT
• IV Methylprednisolone for 3 days.
• Followed by oral prednisolone tapered over 11 days.

42. OPTIC ATROPHY
Refers to optic nerve
shrinkage from any
cause which produces
degeneration of axons
in the anterior visual
system

43. INTRAVITREAL INJECTIONS
• AMD
• CSME/PDR
• Retinal Vein Occlusions
• Endophthalmitis
• Uveitis
• CME
• CNVM secondary to multiple retinal diseases
COMMON INDICATIONS

44. INTRAVITREAL MEDICATIONS
In Retinal vein occlusion/ AMD:
• Bevacizumab (Avastin)
• Ranibizumab (Lucentis)
• Triamcinolone acetonide (Kenalog)
In CMV Retinitis:
• Ganciclovir Intravitreal
In Endophthalmitis:
• Vancomycin 1mg/0.1ml
• Ceftazidime 2.25mg/0.1ml
• Amikacin 0.4mg/0.1ml
• Amphotericin B 0.1ml of 5-10mcg/ml
• Dexamethasone 0.4mg/0.1ml

45. INJECTION SITE
• Usually inferotemporal for ease of access
• Some Retina Specialists give the injection in the
superotemporal quadrant, as they feel that should a
complication such as a retinal detachment form, it can be
easier treated with a pneumatic retinopexy.