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Acquired Macular Disease Flashcards

1
Q

Age-related macular hole ( FTMH)

  1. Who are prone? Male or Female?
  2. Age?
  3. How do they present with?
A
  1. Usually female
  2. In 60s or 70s
  3. Present with
  • severe impairment of central vision
  • asymptomatic deterioration, first noticed when the other eye is closed
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2
Q

Age-related macular hole

Pathogenesis ? What structures involved?

A

Photoreceptors are displaced due to centrifugal force, probably c/b abnormal attachment of the vitreous and fovea

Traction occurs pulling anterior and posteriorly

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3
Q

Age-related macular hole

Stages?

A

Causes several stages

  1. a. Impending
    b. Occult
  2. Early
  3. Established
  4. Greater than 400μm
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4
Q

Macular hole

stages Stage 1a - Impending

Characteristics?

(3)

A

Characterized by

  • flattening of the umbo
  • yellow foveolar spot
  • loss of the foveolar reflex.

Rarely seen clinically

Usually detected in a patient with a FTMH in the other eye

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5
Q

Macular hole – stages Stage 1b - Occult

  1. Vision defect?
  2. What do you see around fovea?
  3. Will it resolve?
A
  1. Patient c/o mild decrease in VA or metamorphopsia
  2. Yellow ring seen around the fovea
  3. About 50% of stage 1 holes resolve following spontaneous separation of the vitreous and fovea
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6
Q

Macular hole – stages Stage 2 – Early FTMH

Size of defect area?

How long does it take to progress from stage 1 to 2?

A

Defect area is less than 400μm in diameter

Can take 1-2 weeks to several months to progress from stage 1 to 2

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7
Q

Macular hole – stages Stage 3 – Established FTMH

Size of defect? Thickness?

A

Stage 3 – Established FTMH

Full thickness defect more than 400μm in diameter

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8
Q

Macular hole – stages Stage 4 – Greater than 400μm

Size of defect?

Appreance?

Effect on VA?

A
  • Round defect more than 400μm in diameter
  • Yellowish deposits within the round defect
  • VA eventually stabilises as the hole reaches its maximum size
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9
Q

Macular hole - diagnosis

  1. Name of simple test diagnosing macular hole? ( Gross diagnosis)
  2. Procedure
  3. How patients with macular hole report?
A
  1. Watzke-Allen test
  2. Projecting a narrow slit beam over the centre of the hole both vertically and horizontally
  3. Patient with a macular hole will report that the beam is thinned or broken
    Patients with a pseudohole or cyst see a beam of uniform thickness which is distorted or bent
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10
Q

Macular hole - diagnosis

What is the most useful diagnosis tool?

A

OCT is useful to diagnose and determine the stage of macular holes

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11
Q

Is FFA useful in diagnosis of Macular hole? Why?

A

Macular hole - diagnosis

  • FFA
  • Not so useful
  • Shows hyperfluorescence which looks similar to:

–Cysts

–Pseudo-holes

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12
Q

Central Serous Retinopathy (CSR)

  1. Aka?
  2. Definition?
  3. Pathogenesis?
  4. Affect one or both eyes?
  5. Nature of this condition?
  6. Who does it mainly affect?
  7. Aggravated ( worsen) by?
A
  1. AKA: central serous chorioretinopathy
  2. Sporadic ( infrequent, periodic) disorder of outer blood-retina barrier
  3. Sensory retina around the macula becomes detached
  4. Usually affects one eye only
  5. Self-limiting
  6. Mainly affects young/middle-aged men with “type A personality”
  7. Aggravated by

–Emotional stress

–Hypertension

–Alcohol

–Reflux

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13
Q

CSR - signs

A

Round/oval detachment of sensory retina at the macula

OCT shows elevation of the retinal layer from the RPE

Separated by optically empty zone

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14
Q

CSR - course

Short - Prolonged - Chronic

A
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15
Q

CYSTOID MACULAR OEDEMA

  1. Caused by?
  2. Any short term effect?
  3. If long standing, can cause what?
  4. Damange reversible?
A
  1. C/b accumulation of fluid in the outer plexiform and inner nuclear layers of the retina
    Fluid-filled cysts form
  2. No short-term effects
  3. If long-standing, can lead to large cavities at the fovea
  4. Irreversible damage to central vision
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16
Q

CMO - presentation

  1. Patient presentation depends on ?
  2. VA affected?
  3. Patient c/o?
A
  1. Patient presentation depends on aetiology
  2. VA could be affected by a pre-existing condition which has caused the CMO
  3. If no pre-existing disease:
    patient c/o:
  • impaired central vision &
  • positive central scotoma
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17
Q

CMO – Slit-lamp signs ?

Fovea?

Retina?

A

On slit-lamp examination you see:

  • loss of the foveal depression
  • thickening of the retina
  • multiple cysts
18
Q

CMO – OCT signs

Retina?

Macula?

Fovea?

A

Hyporeflective spaces within the retina

Overall macular thickening

Loss of foveal depression

19
Q

CMO – FFA signs

  1. Arteriovenous phase?
  2. Late phase?
A
  1. Arteriovenous phase:
    Small hyperfluorescent spots
    Caused by early leakage
  2. Late phase:
    ‘flower-petal’ pattern of hyperfluorescence
    Caused by accumulation of dye within cystic spaces
20
Q

CMO Causes

21
Q

High myopia

•What’s the definition of high myopia?

A

6.00D or more

Axial length greater than 26mm

Excessive elongation- changes to everything

Pathological myopia: elongating and stretching soccer ball into a football => Everything is afffected

22
Q

High Myopia
Pathological or degenerative myopia is characterized by ?

Secondary changes to which structures?

A

Pathological or degenerative myopia is characterized by:

progressive and excessive anteroposterior elongation of the globe

  • Associated with secondary changes involving the: sclera, retina, choroid and optic nerve head
23
Q

Degenerative myopia

A

Tigroid appearance ( Tiger-stripe shape)

Brecks in Bruch’s membrane

Lacquer cracks

Due to diffuse attenuation of RPE with visibility of large choroidal vessels

24
Q

Sign?

A

Degenerative Myopia

Focal choroidal atrophy and titled disc

Optic nerve more rounded/ovally

white= sclera

Black= retinal pigment

Visibility of larger choroidal vessles and evetually sclera

25
Q

Sign?

A

Ruptures in RPE Brunch’s membrane

Choriocapillaris complex

Fine, irregular yellow line branching & corssing @ Posterior pole

Lacquer crack ?

26
Q

Sign?

A

Choroidal neovascularisation

Atrophy

Lacquer cracks

27
Q

Sign?

A

Subretinal coin haemorrhage

28
Q

Sign?

A

Degenerative myopia

Fuch’s spot

29
Q

Degenerative myopia

Any impact on visual acuity

A

Impede on macula

If out in periphery - not going to complain as much

30
Q

Angioid streaks

  1. What is it?
  2. Cause?
  3. Apperance?
  4. Location?
  5. Pattern? in relation to disc?
A

Angioid streaks

  1. Crack-like ruptures in Bruch’s membrane
  2. Occurs as a result of thickened, calcified and abnormally brittle collagenous and elastic portion of Bruch membrane
  3. Linear, grey/dark red lesions with irregular edges
  4. Lie beneath normal retinal vessels
  5. Communicate in a ring-like way around the disc and radiate outwards
31
Q

Angioid streaks

FFA sign?

Cause by?

A

Angioid streaks

•Hyperflurescence is seen on FFA

  • C/b window defects in the RPE
  • FFA is mostly used to detect CNV
32
Q

Angioid streaks

Sign on fundus?

A

•Optic disc drusen are commonly found

•Choroidal rupture following minor ocular trauma causes subretinal haemorrhage

–Eyes with angioid streaks are very fragile!

33
Q

Solar retinopathy

  1. What is it?
  2. Effect on VA?
A

Solar retinopathy

  1. Retinal injury caused by photochemical effects of solar radiation by directly or indirectly viewing the sun (eclipse retinopathy)
  2. Patient presents within 1-4 hours of solar exposure with

–unilateral or bilateral central VA ↓

–small central scotoma

34
Q

Solar retinopathy

Sign on fundus?

Resolve?

A

Solar retinopathy

  • Fundus shows

Small yellow or red foveolar spot

Fades within a few weeks

Spot is replaced by a sharply defined foveolar defect with irregular borders or a lamellar hole

35
Q

Sign?

A

Phototoxic maculopathy

Yellow spot on macula

Burned a hole in both fovea

OCT below= resolve !

36
Q

Case study

62 y/o female

3/52 history of decreased VA

VA RE = 6/18

A

Stage 1B macular hole

Fundus shows cystic appearance at the fovea

OCT shows elevation at the foveal level

Remaining retina bridges over the fovea

37
Q

Case study

69 y/o female

C/o decreased VA worse in the RE, for past few months

VA RE = 6/60

Diagnosis?

A

Full thickness macular hole

Full-thickness hole confirmed on OCT

•Loss of retinal tissue at the fovea

38
Q

Case study

42 y/o male

C/o progressive central vision loss RE over past 1/12

Diagnosis?

A

Central Serous Retinopathy

Dilated fundus exam shows diminished foveal reflex

FFA shows pinpoint leak inferior to the fovea

39
Q

Patient with psuedo-phakic LE

•VA LE = 6/9

A

Drusen

Fundus exam shows drusen

FFA shows late staining of the areas of drusen

OCT shows altered foveal contour

40
Q

45 y/o female

Referred for evaluation central visual distortion in RE for 6/12

VA RE = 6/7.5

Diagnosis?

A

Angioid Streaks

OCT shows normal neurosensory retina and normal foveal contour

Choroid on the RHS shows irregularity

41
Q

60 y/o female

C/o decreased VA RE 1/12 post cataract Sx & IOL insertion

VA RE = 6/30

Diagnosis?

OPM (10 decks)

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