16 - Retina/Choroid4 Flashcards
Gyrate atrophy
- epidemiology
- pathophys
AD, symptoms by age 10
BILATERAL chorioretinal degeneration due to deficiency in MITOCHONDRIAL ENZYME ORNITHINE AMINOTRANSFERASE
-ornithine blood plasma levels will be HIGH
Gyrate atrophy
-signs/symp
Signs: multiple, well-defined, scalloped areas of peripheral chorioretinal atrophy
- begin in mid-periphery (childhood), coalesce to engulf most of post pole w/ macula being SPARED UNTIL 4th-7th decade
- assoc with PSC, high myopia/astimatism
Symp: NYCTALOPIA, decr vision, constricted VF
Rhegamatogenous retinal detachments
- epidemiology
- risk factors
Males, >45yo
Risks:
- previous ocular surgery
- PVD (10-15% with acute symptomatic PVD -> RRD)
- trauma
- family hx
- MYOPIA = #1, 40% of all RDs
- lattice degen (30% of RRDs have lattice, only 1% with lattice have RRD)
Rhegamatogenous retinal detachments
-key words to think of
Full-thickness retinal break/defect
Rhegamatogenous retinal detachments
-pathophys
Result from RETINAL BREAKS (full-thickness retinal defects) that allow vitreous into subretinal space -> separation of sensory retina from RPE
-breaks = atrophic HOLES, vitreo-retinal traction TEARS
Breakdown of retinal detachment sub/categories
Rhegmatogenous:
- atrophic holes
- traction tears (vit pulls retina)
Non-rheg:
- DRVOS (preret neo) = tractional (vit pulls neo)
- CHBALA (subret neo) = exudative/serous
Rhegamatogenous retinal detachments
-atrophic holes
Round, small, full-thickness defects that aren’t assoc with traction -> LOW RISK FOR SUBSEQUENT DETACHMENT (i.e. less concerning than retinal tears)
Caused by CHRONIC ATROPHY of sensory retina
Most likely TEMPORAL retina (SUPERIOR > inferior)
Rhegamatogenous retinal detachments
-retinal tears
Caused by VITREOUS TRACTION
Flap/horseshoe/U-tear: due to UNEVEN vitreous traction
-worse than operculated due to PERSISTENT traction
Operculated: due to EVEN, SYMMETRIC vitreous traction, PULLS AWAY/no longer persists
Rhegamatogenous retinal detachments
-signs/symp
Signs:
- acute: convex, undulating, clear subret fluid that doesn’t shift with body position, SHAFER’S sign, mild iritis, LOWER IOP
- chronic: PIGMENT DEMARCATION LINE (3mo+ to develop), intraretinal cysts (1yr+), fixed folds, and/or subret precipitates
Symp: floaters, flashes, curtain/veil, decr VA
Rhegamatogenous retinal detachments
-most likely location
SUPERIOR TEMPORAL (60%)
50% of eyes with RRD will have more than one retinal break - usually 90 degrees from one another
Lattice degeneration
-epidemiology
Common (6-10% pts)
20-33% of pts with RRD have lattice, but only 1% with lattice have RRD
-most common peripheral retinal lesion assoc with RDs
Lattice degeneration
-what/app
Area of peripheral retinal thinning - typically circumferential (CIGAR-SHAPED) and CONCENTRIC to ora serrata
- inner portion: atrophic/thin
- outer margins: firm adhesion to vitreous
Majority of lesions DO NOT contain the criss-cross pattern of white sclerosed vessels (only 12% have)
Often bilateral (33-50%), SUPERIOR TEMPORAL
25% will contain an atrophic hole
Conditions assoc with “lattice-like” lesions/“atypical lattice” (3)
Marfan’s
Stickler
Ehlers-Danlos
*at incr risk for an RD
Vitreoretinal tufts
Small, focal areas of vitreous TRACTION located in periphery
Occur in 5% pop - 2nd most common peripheral retinal lession assoc with RD (lattice #1)
-less than 1% develop an RD
Non-rhegmatogenous retinal detachments
- include (2)
- by definition, these RDs are not cause by __
Serous/exudative RDs + Traction RDs
Retinal breaks
Non-rhegmatogenous retinal detachments
-exudative RDs
From SUBRETINAL disorders = CHBALA -AMD is most common -others: —inflammatory: scleritis —vascular: Coat’s —neoplasms: choroidal melanoma —miscellaneous: coloboma
Asymptomatic unless macular involvement
Non-rhegmatogenous retinal detachments
-traction RDs
From PRE-RETINAL disorders = DRVOS
-esp PDR, ROP, sickle-cell
Usually no complaints/symp; decr vision, progressive VFD
Age-related degenerative retinoschisis
- epidemiology
- pathophys
4-7% of gen pop, esp in 40yo+
70% of pts are HYPEROPIC
Degenergative process resulting from SPLITTING OF OPL and INL -> elevation of inner retina that mimics a detachment
Age-related degenerative retinoschisis
-signs/symp
Signs: dome-shaped bullous elevation, esp INFERIOR-TEMPORAL (70%)
- unlike retinal detachment: retina is immobile, BILATERAL common, ABSOLUTE VFD corresponding to area of elev (periph, so no biggie)
- “snowflake” or “frosting” and sheathed retinal vessels
Symp: asymptomatic
Age-related degenerative retinoschisis
-inner vs outer wall breaks
Outer: more dangerous - required to cause a retinoschisis-assoc RD, appear “pock-marked” on scleral depression
Angioid streaks
-pathophys
Damage to ELASTIC core -> large breaks in Bruchs
50% IDIOPATHIC
PEPSI: pseudoxanthoma elasticum, ehlers-danlos, paget’s, sickle-cell, idiopathic
Angioid streaks
-signs/symp
Signs: spoke-like, linear, well-demarcated red/orange or brown lines within elastic core of Bruchs, FROM THE DISC
Symp: asymptomatic; profound vision loss from CNVM
-70% will eventually have some vision loss
Toxocariasis
-pathophys
Toxocara canis/cati - intestinal nematode
- from eating dirt/infected veggies, meat, water or thru contact with infected kittens
- after ingestion, larvae penetrate the intestinal wall -> travel to eye, brain, skin, liver, lungs
Common in children/young adults
Toxocariasis
-signs/symp
Signs: significant UNILATERAL INFLAMMATORY response
- optic nerve edema, RD, vitritis, endophthalmitis, subret granulomas
- large, white chorioretinal scars present AFTER active infection resolves
Symp: floaters, blur
Acute posterior multifocal placoid pigment epitheliopathy
aka White Dot syndrome
Young adults - typically after VIRAL illness
BILATERAL, yellowish, flat, subretinal lesions
-may have disc edema, RD
Usually resolves without tx in few weeks
Central areolar choroidal dystrophy
AD
Bilateral large areas of GA in the macula
Vision loss in 4th-5th decade
-poor prognosis
