Acquired Macular Disease Flashcards
Age-related macular hole ( FTMH)
- Who are prone? Male or Female?
- Age?
- How do they present with?
- Usually female
- In 60s or 70s
- Present with
- severe impairment of central vision
- asymptomatic deterioration, first noticed when the other eye is closed
Age-related macular hole
Pathogenesis ? What structures involved?
Photoreceptors are displaced due to centrifugal force, probably c/b abnormal attachment of the vitreous and fovea
Traction occurs pulling anterior and posteriorly
Age-related macular hole
Stages?
Causes several stages
- a. Impending
b. Occult - Early
- Established
- Greater than 400μm
Macular hole
stages Stage 1a - Impending
Characteristics?
(3)
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
Macular hole – stages Stage 1b - Occult
- Vision defect?
- What do you see around fovea?
- Will it resolve?
- Patient c/o mild decrease in VA or metamorphopsia
- Yellow ring seen around the fovea
- About 50% of stage 1 holes resolve following spontaneous separation of the vitreous and fovea
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/024/329/a_image_thumb.png?1444378706)
Macular hole – stages Stage 2 – Early FTMH
Size of defect area?
How long does it take to progress from stage 1 to 2?
Defect area is less than 400μm in diameter
Can take 1-2 weeks to several months to progress from stage 1 to 2
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/024/389/a_image_thumb.png?1444379734)
Macular hole – stages Stage 3 – Established FTMH
Size of defect? Thickness?
Stage 3 – Established FTMH
Full thickness defect more than 400μm in diameter
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/026/311/a_image_thumb.png?1444379833)
Macular hole – stages Stage 4 – Greater than 400μm
Size of defect?
Appreance?
Effect on VA?
- Round defect more than 400μm in diameter
- Yellowish deposits within the round defect
- VA eventually stabilises as the hole reaches its maximum size
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/026/364/a_image_thumb.png?1444379948)
Macular hole - diagnosis
- Name of simple test diagnosing macular hole? ( Gross diagnosis)
- Procedure
- How patients with macular hole report?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/026/398/q_image_thumb.png?1444380027)
- Watzke-Allen test
- Projecting a narrow slit beam over the centre of the hole both vertically and horizontally
- 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
Macular hole - diagnosis
What is the most useful diagnosis tool?
OCT is useful to diagnose and determine the stage of macular holes
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/026/458/a_image_thumb.png?1444380225)
Is FFA useful in diagnosis of Macular hole? Why?
Macular hole - diagnosis
- FFA
- Not so useful
- Shows hyperfluorescence which looks similar to:
–Cysts
–Pseudo-holes
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/026/877/a_image_thumb.png?1444381379)
Central Serous Retinopathy (CSR)
- Aka?
- Definition?
- Pathogenesis?
- Affect one or both eyes?
- Nature of this condition?
- Who does it mainly affect?
- Aggravated ( worsen) by?
- AKA: central serous chorioretinopathy
- Sporadic ( infrequent, periodic) disorder of outer blood-retina barrier
- Sensory retina around the macula becomes detached
- Usually affects one eye only
- Self-limiting
- Mainly affects young/middle-aged men with “type A personality”
- Aggravated by
–Emotional stress
–Hypertension
–Alcohol
–Reflux
CSR - signs
Round/oval detachment of sensory retina at the macula
OCT shows elevation of the retinal layer from the RPE
Separated by optically empty zone
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/027/905/a_image_thumb.png?1444392733)
CSR - course
Short - Prolonged - Chronic
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/034/628/a_image_thumb.png?1444392788)
CYSTOID MACULAR OEDEMA
- Caused by?
- Any short term effect?
- If long standing, can cause what?
- Damange reversible?
- C/b accumulation of fluid in the outer plexiform and inner nuclear layers of the retina
Fluid-filled cysts form - No short-term effects
- If long-standing, can lead to large cavities at the fovea
- Irreversible damage to central vision
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/034/723/a_image_thumb.png?1444393040)
CMO - presentation
- Patient presentation depends on ?
- VA affected?
- Patient c/o?
- Patient presentation depends on aetiology
- VA could be affected by a pre-existing condition which has caused the CMO
- If no pre-existing disease:
patient c/o:
- impaired central vision &
- positive central scotoma
![](https://s3.amazonaws.com/brainscape-prod/system/cm/163/035/012/a_image_thumb.png?1444393216)