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Retina Review

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kuleya's version from 2016-03-09 06:11

Retina Review

Question Answer
Asteroid hyalosis compositioncalcium soaps
Risk factor for asteroid hyalosisDM and HTN
Maltese cross birefringence in what?asteroid hyal
What differentiates synchisis scintillans from asteroid?asteroid much less mobile, cholesterol in synchisis (old vitreous hemorrhage)
Primary Amyloidosisis a thing amyloid enters retinal vessels
Posterior vitreous detachment, what is risk of tear?70%. 10-15% symptomatic PVD
Commotio retinae is what pathologically?thinning of outernuclear and plexiform layers with photoreceptor loss
Difference in choroidal rupture from direct and indirect trauma?direct – anterior at site of impact (parallel to ora serrate)…indirect – posterior, concentric and temporal to optic disc with vit heme ((CNV can happen late late late…rupture scars at 1 month~
Retina scleropteria carries what riskoof RD?LOW in young patients…. what!?
Most common traumatic tear associated with RD?dialysis (inferotemporal > superonasal) half present within 8 months of trauma, but can occur later.
Fish mouth appearance of tear?Oral at ora serrate due to split of vitreous
Tx of horseshoe tear?laser (traumatic tear)
Tx of operculated tear?laser (traumatic)
Tx of non RD associated traumatic retinal dialysis?laser
Tx of RD 2/2 tear?buckle
tx of traumatic macular hole?vitrectomy with teh GASSSS
Purtcher’s retinopathy is what?ischemia/papillitis 2/2 to distal trauma causing injury induced complement activitation and leukocyte embolization
Purtcher’s is associated with what?SLE, distant trauma, pancreatitis, leukemia, amniotic fluid emboli, dermatomyositis
What is Terson syndrome?sub-ILM blood from intracranial hemorrhage
whiplash injury will damage what?foveal early hyperfluorescence with 50-100 mcm foveal pit
Epiretinal membrane looks big on OCT, what does patient sense?unsure! no correlation
ERM is associatefd with what disease?DM, vascular occlusion, PVD, high myopia, retinal hole/tear, prior surgery or laser, age….causes striae/folds
Most commonly a macular hole is caused by?idiopathic
Gender preference in macular hole? laterality? risk of developing in fellow eye?female > male, 25-30% bilateral, <1% risk of developing in fellow eye if PVD is present there
FA of macular hole?window defect
Describe Stage 1 hole?yellow spot, impending with foveal detachement and macular cyst
Describe Stage 2 hole?full thickness hole with opcerculerum, <400 mcm in diameter, posterior hyaloid is attached to fovea and disc (VMT with small hole)
Describe Stage 3 hole?fully developed > 400 mcm, vitreous detached from fovea, attached to disc… large hole but NO VMT
Describe Stage 4 hole?PVD with full hole
What is Watzke Allen sign? When do you see it?slit beam scotoma over stage 3 hole
How long does it take to get solar retinopathy?90 seconds..caused by blue or UV light .. vision usually 20/100 or better, improves to 20/20-40
FA of solar retinopathy?RPE Damage stains intensely acutely, window defect later, NO leakage
CSCR associated with what?HTN, steroid use, psychiatric medication use, type A personality
Smokestack appearance of FA is noted, what findings do you see on fundus exam?blunted foveal reflex, Serous central RD, pigment epithelial detachment, RPE change
80% of CSCR patients have what FA findingexpansile dot
PDT can help in what CSCR scenarios?persistent >3 months serous RD, previous episode of CSCR in same eye, episode in other eye with vision loss, demand for rapid recovery due to occupational demands --- does not help final outcomes
Prognosis of CSCR?90% spontaneous improvement, 66% 20/20, 15% with bilateral vision loss
Recurrence rate of CSCR?50%
DDx of PED <50 yoa patient?CSCR
DDx of PED > 50 yoa?drusen? -- > occult CNV
RF for AMD?age, heredity, female, white, smoker, nutrition, photic exposure, HTN, light iris color, hyperopia
Genes, location, products and relative risk of AMD (hetero AND homozygosity…)CFD (1q31) – complement factor H, X – 4x risk, XX – 7x risk….. ARMS (10q26) – X 3x risk, XX 8x risk….combination of homo CFH, homo ARMS = 50x risk
drusen stain PAS positive!niiice
path of soft drusen?thickened inner bruchs…look like PED
basal laminar drusen FA findings?blocks early stains late
sharply demarcated drusen associated with what RPE finding?RPE atrophy … calcific drusen
Sizes of drusen?small < 64 mcm, medium 64 -124, large > 125 mcm (vein diameter at disc margin)
DDx of foveal yellow spot?best disease, solar maculopathy, stage 1a hole, pattern dystrophy, CME, CSR, old hemorrhage
FA of drusen?early windo defect with late staining
classic CNV on FA?progressively brightening early hyperfluorescence that leaks outside the margins late
what types of occult CNV on FA?fibrovascular PED (irregular early mottle RPE hyperfluorescence followed by progressive stippled hyperfluorescent leakage less bright than classic…late leakage of undetermined origin – stippled RPE hyperfluorescence late but nothing early
Types of CNV?type 1 – under RPE, type 2 – above RPE (type 3- retinal angiomatou proliferation – bilateral with small IRH and PED)
Extrafoveal CNV is where?> 200 mcm – 2500 mcm from FAZ
Juxtaoveal CNV is where?1-199 mcm from FAZ or farther but with blocked fluorescence within 200 mcm of FAZ….other one is subfoveal duh
ICG would show what in CNVfocal hot spots or plaque of late hyper
Avoid what in smokers?beta-carotene
What areAREDS1 vitamins?vitamin c, Vitamin E, beta carotene !STOPPED!, zince, cupric oxide
What are AREDS2 vitamins?lutein 10 mg, zinc 80 mg, zeaxanthin 2 mg, vitamin E 400 IU, vitamin C 500 mg
Point system for AREDS?large drusen 125 mcm 1 point, pigment change 1 point, if no large drusen – bilateral intermediate drusen 60-124 1 pt, neovascularization 2 pts
Macular photocoagulation study (MPS) showed?extrafoveal/juxtafoveal CNV focal laser showed 46% 6 line vision loss at 5 years compared to 64% untreated.
TAP trial showed?PDT verteporfin showed improvement in tx subfoveal classic or occult CNV (without classic)
VISION trial showed?pegaptanib approvale (selective VEGF antagonist binding 165 isoform of VEGF-A) every 6 wks.
MARINA showed what?ranibizumab for occult CNV and minimally classic CNV better than sham
Category 1 AMD in AREDS?fewer than 5 small drusen
Category 3 AMD in AREDS?extensive intermediate sized drusen or >=1 large drusen or noncentral geographic atrophy ..AREDS help here
Category 2 AMD in AREDS?multiple small drusen of single or nonextensive intermediate drusen, or pigment abnormlities
What is extensive intermediate drusen?if soft, indistinct drusen are present and the total area occupied by the drusen is equivalent to the area that would be occupied by 20 drusen each having a diameter of 100 mcm. if no soft dursen present, intermediate drusen are extensive when area is equivalent to 1/5 disc area
HLA typing for POHS?B7 or DRw2
Primary histo from what?spore inhalation into respiratory tract
primary choroidal histo fundus findings.granulomatous clinically unapparent that reslves in to small atrophic scar that disrupts bruchs
Risk of POHS CNV?1% if normal disc/macula, 25% at 4 years if disc/macula abnormalities
Angioid streaks mnemonic?PEPSI - PXE, Ehlers-Danlos, Pagets disease (increased bone production), Sickle cell, Idiopathic (50% of the time)
Systemic findings of pseudoxanthoma elasticum?autosomal recessive, female… increased elastic tissue, mucoscal vascular malformations causing GI bleed…85% with angioid streaks p’eau dorange retina
Pathologic Myopia parameters?axial length 32.5, >-8D myopia
High myopia parameters?26.5 mm axial length, -6D myopia
Posterior staphyloma with lacquer cracks seen in what?pathologic myopia
Signs of lacquer cracks?sudden decrease in teenager vision with focal SRH centered on fovea obscuring crack
CNV risk in pathologic myopia? Epidemiology?young patients, bilateral 12-40% of time.
Where is edema in CME?muller cells
DDx of blood in every retinal layer?macroaneurysm, melanoma_CH, trauma, sickle cell, leukemia, vein occlusion (meh), CNV (rare)
Most common form of juxtafoveal telangiectasia?type 2A – acquired, bilateral, male = female, 50-70 yoa, symmetric, small <1DD, … other shit… singerman spots… 1/3 abnormal glucose tolerance test
KWB classification of HTN, group 1minimal constriction + tortuosity
KWB classification of HTN, group 2moderate construction, focal narrowing, AV nicking
KWB classification of HTN, group 3group II plus CWS/heme/hard exudaes
KWB classification of HTN, group 4group III plus disc edema
Scheie HTN retinopathy grade 0nothing
Scheie HTN retinopathy grade 1narrowing
Scheie HTN retinopathy grade 2narrowing + focal constriction
Scheie HTN retinopathy grade 32 + IRH
Scheie HTN retinopathy grade 43 + disc edema
Siegrist streak is what? sign of what?reactive RPE hyperplasia along sclerosed choroidal vessel… HTN
Elschnig spot is what? sign of what?zone of nonperfusion of choriocapillaris; pale white or red patches of RPE
endothelial hyperplasia + av nicking in path of HTN retinopathyyay!
Leading cause of new blindness in US 20-74 yoa?DM
Severe NPDR is what?IRH in 4 quadrants OR venous beading in 2 quadrants OR 1 IRMA…1 of above
Very severe is what?2 of the 4-2-1 rule.. IRH, beading, IRM (respectively)
High risk PDR is what?NVD > ¼ to 1/3 disc area, ANY NVD with VH, or NVE >1/2 DD with VH
No benefit of aspirin for DR was shown in what study?ETDRS (focal laser decreases vision loss from CME in 50%)
DRS showed what?PRP reduces incidence of sever vision loss in high risk PDR
Severe NPDR defined as what in DRS?CWS, venous beading IRMA, lots of heme
Sickle cell retinopathy most commonly in what subtypes? SC >> Sthal
Progression of Sickle cell NV?Lots resolve
Can angioid streaks happen in sickle cell?FUCK YEAH
Comma-shaped conjunctival vessels occur in what?Sickle cell
Stage 1 Sickle cell is what? Stage 2? 3? 4? 5?1 arteriolar occlusion, 2 peripheral anastomoses, 3 NV, 4 vitreous hemorrhage, 5 RD
Middle eastern dude with NV and perivasculitis, what is it?eale’s disease.. increased risk of BVO
Findings in Eale’s disease?NV, perivasculitis, AC rxn, KP, vitritis, macular edema, retinal nonperfusion… early is sheathing of venules/retinal edema/heme,, late is prolferative retinopathy and VH/TRD
RF for BRVO?HTN, obese at age 20, CVD, age > 60, glaucoma, papilledema, optic disc drusen
Define ischemic BRVO?>= 5 DD capillary nonperfusion
Define nonischemic BRVO.< 5DD capillary nonperfusion
Grid laser when for BRVO?vision is < 20/40 for CME for > 3 months without macular ischemia on FA
Sector PRP for NV and VH in BRVO…OKOKOKOK
BRVOStudy showed?perform grid argon laser for macular edema and vision < 20/40 for 3 months
GENEVA study showedwhat?Osurdex helps BRVO macular edema huzzahhh
risk of NVI from ischemic brvo?low
risk of NV from ischemic BRVO?40%
Toxoplasma chorioretinitis classic oral regmina?pyrimethamine, folinic acid, sulfadiazone…can use intravitreal dex and clinda
Reactivation toxo looks like what?inflammation next to old scar
Headlight in fog lesion?toxo…vitritis plu granulomatous masss
findings in congenital toxo?stillbirth, MR, seizure, hydrocephalus, microcephaly, calcifications, HSM, committing, diarrhea
what toxo don’t you treat?Small peripheral lesions can regress spontaneously
Where are changes on OCT for MEWDS?outer layer, RPE, can have neuropathy and APD
CVOS said what?PRP don’t prevent NVI in CRVO, wait till NVI develops
Choroidal rupture patients get CNVM!!!OKOKOK
Waxy pallor of optic nerve + attenuation of vessels is like what?RP I guessssss
Most common hereditary retinal degeneration?Retinitis pigmentosa 1:5000 ppl
Most common RP form? inheritance? type rod cone 1, AR 37%
CNV rare in serpiginous, MAY respond to immunomodulation but probs notcool
FA finding in birdshiginous retinopathy? HLA?quenching of arterial filling
Types of cystinosis?benign, late-onset, nephropathic ( only nephron causes retinal disease but doesn’t affect vision)..defect is in lysosomal transport
anterior segment findings in bartonella neuroretinitis?parinaud oculoglandular syndrome. – granulomatous palpebral conj nodules and ipsilateral preauricular/submandibular adenopathy
power of eye/power of lens = what?magnification
Lattice Degeneration risk factors for RD?high myopia, flap tears, hx of RD in other eye, APHakia
EDVS showed need for early vitrectomy in who?severe VH in type 1 DM
When should you use grid laser according to BVOS?>=3 months of <20/40 vision in chronic macular edema
Retinal macroaneurysm shows retinal heme in what layer?ALL!
retinal macroaneysm at what kind of arteriole?second order…chronic hypertensioN
SCORE CRVO showed what?same improvement in visual function in 1mg and 4 mg triamicinolone (26% 3 lines) …much better than observation
SCORE BRVO showed what?showed no improvement of triamcinolone over grid laser
Angioid streaks can cause CNVM? what is major cause?pseudoxanthoma elasticum (Gronblad Strandberg syndrome)…ABCC6 chromose 16 can have optic disc drusen and peaudorange and comet shaped peripheral calcified lesion
PLAQuenil toxicity happens in high BMI why?BC weight based dosing is inappropriate- does not accumulate in fat
AZOOT and MEWDS have what similar symptoms?fucking photopsia
BEAT ROP compared qwhat?retinal ablative therapy with IVA monotherapy
Bleb-related endophthalmitis from what?strep and staph more than hemophilus… tx with vitrectomy and abx, DESPITE findings from endophthalmitis vitrectomy study
When do you proceed directly to vitrectomy according to EVS?LP or worse vision in endophthalmitis following cataract surgery
scleritis from p-ANCA disease…systemic findings?cartilaginous structure inflammation in relapsing polychondritis
vitreal involvement of PIC?none
which IOP meds are bad in uveitis?pilo and prostaglandins
rubella can cause salt and pepper stuff!OK!
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