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CC July 2017 Retinal Detachment

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echoecho's version from 2018-04-25 05:57

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Question Answer
Retinal detachment is the most common emergency of the retina that threatens sight, with an estimated incidence of 1 in _______ individuals per year?10000
List the risk factors for retinal detachment?1) increased age 2)myopia (up to 3 diopters of myopia increases the risk 4-fold; greater than 3 diopters of myopia increases the risk 10-fold) 3) previous cataract surgery 4) blunt ocular trauma
Are hyperopia or diabetes associated with increased risk of retinal detachment?No
In myopic women, does the stress of natural childbirth increase the risk of detachment?No
*** It has been suggested that the use of what oral antibiotic may increase the risk of detachment, but this has not been evaluated in prospective studies?Fluoroquinolone
What is the most common risk factor for retinal detachment?The opposite eye
The above is estimated to occur at a rate of ___% to ___% in the contralateral eye during the first year and up to____% within 4 years?3.5%; 5.8%; 10%
List the 3 major types of retinal detachments?1) Rhegmatogenous 2) traditional retinal detachment 3) exudative retinal detachment
Regarding the Rhegmatogenous detachment ("arising from a rupture"), describe what happens? Is this the most common type of retinal detachment?1) liquified vitreous humor passes through a hole in the retina, separating the neurosensory retina from the retinal pigment epithelium 2)the most common type of retinal detachment seen
Regarding the Rhegmatogenous detachment, describe why this happens? What zone is this commonly seen in?1) deterioration of the collagen fibrils that stabilize the vitreous humor leads to progressive loss of vitreous elasticity. The vinous contracts in certain areas of the retina, pulling away from the retina and resulting in excessive traction in other areas where contact is maintained. 2) seen most commonly in the transition zone between the central and peripheral retina, where the retina is thinnest
Regarding traditional retinal detachment, describe what happens? Is it much less commonly seen?1) abnormal traction on the retina by cords of scar tissue such as seen in fibrosing proliferative diabetic retinopathy 2) much less commonly seen
Regarding exudative retinal detachment, describe what happens? Is it the least common form?1) it is the result of barrier dysfunction in the retina as may be seen in cases of intraocular tumors or exudative vascular diseases. 2) yes
What do most patients with retinal detachment report as to symptoms prior to the actual event? How are these described? Is it easy fo the patient to localize the symptoms to the affected eye?1) abnormal visual symptoms 2) "cobwebs" or a collection of small opacities or even flashes of light. 3) no, it is difficult
What does the patient perceive once the detachment occurs?a light gray to dark gray shadow that does not move when they move their gaze
A detachment in what region of the eye may be associated with a more significant disruption of vision?the fovea (site of maximum concentration of cones
Unfortunately, many patients with retinal detachment do not recognize the seriousness of these changes and present for care after a significant time interval has elapsed, true or false?true
What symptoms would an acute-angle closure glaucoma typically have?hazy or blurred vision, headache or eye pain, rainbow-colored circles around bright lights and occasionally, loss of sight
What symptoms would a macular degeneration patient have?decreased central vision, distortion of faces, and difficulty seeing in low light conditions
Although vision affected by diabetic retinopathy can present with _____, similar to a retinal detachment, symptoms are commonly noted in _____ eyes, with fluctuating visual changes that are slowly progressive?1) floaters 2) both
What symptoms would a patient with cataracts have?1) gradually increasing symptoms of decreased vision in low light and when driving at night 2) fading or yellowing of colors 3) sensitivity to light 4) "halos" around bright lights
What treatment for retinal detachment should be done and why?an ophthalmologic emergency referral because this is an ophthalmologist emergency
What must be identified by fundoscopy and repaired?tears in the retina
Vision restoration is much more likely in the _____ setting?acute
When can laser photocoagulation and cryocaogulation be used?since these procedures form scars between the retina and the retinal pigment epithelium and can only be used if both layers are still in contact with each other
Regarding sclera buckling procedures, describe the procedure? What are common side effects?1) a foam sponge sutured to the sclera reduces the traction pressure of the vitreous on the retina, giving time for the retinal pigment epithelium to reabsorb the fluid trapped between the layers 2) deforming of the shape of the globe and changes in refraction
Describe the vitrectomy procedure?the vitreous humor causing the detachment is first removed, a tamponade is then used to force the fluid out from between the retinal layers and the holes are closed via a coagulation procedure. Finally the vitreous is replaced with a tamponade
What are the complications of the vitrectomy procedure?1) cataract formation 2) temporary blurry vision 3) creation of other retinal holes
What is the success rate for the sclera buckling procedure and the vitrectomy procedure?85%-90%
*** A 2015 Cochran review concluded that there was insufficient evidence to recommend one procedure over the other, true or false?true
What if a retinal hole is found incidentally in an asymptomatic patient, what is the therapy?current practice does NOT support prophylactic treatment with coagulation therapy. Such therapy may be considered in patients at night risk of detachment (previous hx of detachment, s/p bout ocular trauma)
*** SUMMARY = Retinal detachment is an ophthalmologist ______ and failure to dx and treat could result in loss of sight?emergency
*** SUMMARY = List the risk factors of retinal detachment?1) hx of retinal detachment in the opposite eye 2) advanced age. 3) myopia. 4) hx of cataract surgery 5) blunt ocular trauma
*** SUMMARY = The success rates for what two procedures approach 85-90%?1) sclera buckling. 2) vitrectomy
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