62. Posterior Segment Disease

Question 1

What is posterior vitreous detachment?

Answer 1

sx: floaters: due to opacities in vitreous cavity
flashes: stimulation of retina due to pulling in still attached areas
occurs due to age

Question 2

What is Retinal Detachment? Signs and Types (tx for types)

Answer 2

Signs: flashes, floaters, curtain/veil visual defect
Types:
1. Rhegmatogenous - break in retina (tx: flatten it out)
2. Exudative - fluid under retina (tx lesion)
3. Tractional - fibrous elements pulling (tx DM/cause)

Question 3

Which circulation drains via vortex veins?

Answer 3

Choroidal circulation (ciliary a.)

Question 4

Retinal Artery Occlusion vs. Retinal Vein Occlusion

signs, type of pt, tx

Answer 4

RAO

• sudden painless loss of vision
• amaurosis fugax - blindness in one eye (due to emboli)
• acute vision loss= EMERGENCY (stroke/TIA of eye)
• Cherry Red Spot - fovea pronounced due to surrounding ischemic RPEs near fovea

RVO

• sudden painless loss of vision
• older pts with DM, HTN
• complications: retinal swelling, neovascularization of iris (acute angle closure glaucoma)
• tx: anti-VEGF, focal laser

Question 5

Diabetic Retinopathy

• changes to retina
• pathogenesis (tx for stages)

Answer 5

Most common cause of blindness in working age
Retina changes: loss of pericytes/endothelial cells, b.m. thickening, decompensated endothelial function, leakage/occlusion of microvasculature
Pathogenesis:
1. Nonproliferative DR: microaneurysm formation + Cotton Wool Spots (nerve fiber swellings), flame/blot hemorrhages (microaneurysm bursts), hard exudates/macular edema (TX: anti-VEGF)
2. Proliferative DR: RETINAL neovascularization and preretinal hemorrhage (can cause retinal detachment)

Question 6

Causes for vision loss in DR

Tx for DR

Answer 6

1. Macular Edema (fluid under retina)
2. Neovascularization
3. Macular Ischemia

Tx: Laser off surface peripheral retina (decrease VEGF load, eliminate microaneurysms), anti-VEGF

Question 7

What are the 2 features of hypertensive retinopathy?

Answer 7

vessel hardening and cotton-wool spots

Question 8

Age-related macular degeneration (AMD)

• what is it
• where does vision loss occur
• progression
• tx

Answer 8

commonest cause of untreatable vision loss in elderly
Vision loss begins in center and spreads peripherally
-distortion/deterioration of central vision acuity

Progression
Early: Dry/Non-exudative: drusen (yellow dots in fovea)
Intermediate: Dry - geographic atrophy (loss of tissue)
Exudative: Wet - CHOROIDAL neovascularization - retinal bleeding/fibrosis - disciform scarring

Tx: lifestyle (smoking cessation), Anti-VEGF for Wet AMD, vitamin supplements to reduce AMD progression