Case 23: Flashes of Light Flashcards
Posterior vitreous detachments (PVDs) result from detachment of the _______ _____ of the vitreous from the retina
Posterior hyaloid
___% of people over the age of 50 have a PVD
50
Rhegmatogenous RDs are characterized by what 2 things?
Atrophic holes, retinal holes
Non-rhegamtogenous RDs are characterzied by what 2 things?
Exudate, traction
Photopsia in eyes w/ an acute posteior vitreous detachment is thought to result from traction on the retina at sites of _______ _____
Vitreoretinal adhesion
PVDs more common in which gender?
Females
Risk factors of PVD
diabetes mellitus, intraocular surgery, intraocular inflammation, vit heme, trauma
MC cause of retinal tear?
PVDs & vitreous liquefaction
RD
separation of sensory retina from underlying RPE
Rhegmatogenous OD
result from retinal break
Atrophic hole
Small, round, full-thickness defect caused by chronic atrophy of sensory retina (NOT vitreoretinal traction); assoc w/ low risk for a subsequent RD. Most often located in the temporal retina (superior> inf) often assoc w/ lattice degen
Retinal tears
Caused by vitreous traction
Flap tear
Result of uneven vitreous traction; the vitreous traction often persists after the retinal tear occurs (vitreous remains attached to the flap), leading to an increased risk of a subsequent RD compared to operculated tears
Operculated tear
symmetric & the result of even vit traction, vit traction no longer persists after the tear, reducing the risk of subsequent RD
Exudative RD
Accumulation of fluid underneath the sensory retna due to damage to the RPE
MC cause of exudative RD
ARMD
MC cause of tractional RD
Proliferative diabetic ret
RRDs MC occur in which gender?
Male
___% of eyes that develop RRD will have assoc lattice, however only ___% of eyes w/ lattice degen will develop a RRD
20-33, 1
____% of pts w/ an acute symptomatic PVD will have a retinal break
10-15
In FHx of RRD or previous occurrence of RRD: both eyes are eventually affected in ____% of cases
10
____% of all RDs occur in myopic eyes
40
Signs of chronic RRD
Linear pigment demarcation line (takes 3 mo or longer to develop), intraretinal cysts (after 1 year), fixed folds, and/or subretinal precipitates
The quadrant location in which pt reports ______ is of no value in predicting the location of the primary retinal break; however, the quadrant location for _____ is often valid
photopsia, VF defect
Classical migraine
preceded by a visual aura that develops over 5-20 min & lasts less than 60 min
Tx of symptomatic lattice degen (flashes/floaters)
Prophylactic tx w/ cryopexy or laser photocoagulation
2nd MC lesion assoc w/ RD
vitreoretinal tuft
When do you treat symptomatic retinal tear?
Immediately
Retinal break tx
Laser photocoagulation or crytherapy; these techniques create a strong adhesion between the retina & RPE so vitreous fluid entering the retinal break cannot spread & create an RD
Tx macular-detached RDs (“mac off”)
Usually result in a permanent reduction in vision; these RDs should be treated urgently (48-96 hours)
Tx macular-threatening RDs (“mac on”)
Tx IMMEDIATELY 24 hours
pneumatic retionpexy
intravitreal gas bubble is injected to temporarily tamponade the retinal tissue against the RPE: prevents additional vitreous fluid from entering the tear & allows the RPE to pump excess subretinal fluid into the choroid -> laser photocoagulation or cryotherapy is then used to permanently seal the retinal break
Pneumatic retinopexy is primarily used for ______ retinal breaks
Superior
Scleral buckle
A flexible silicone strip is permanently sutured on or within the sclera in order to indent the sclera & relieve vitreoretinal traction associated w/ the retinal break
SE of scleral buckle
induced myopia, pain, hemorrhage, infection, diplopia
vitrectomy
removal of the vitreous allows release of vitreoretinal traction
Common indications for a vitrectomy w/ retinal breaks (2)
- inability to visualize the retinal break as a result of a cloudy vitreous 2. inability to close retinal breaks through standard techniques, typically as a result of a very large breaks, posterior breaks that include a macular hole, & severe vitreoretinal traction
Post-operative complications of tx of RD
elevated IOP, cataracts, hemorrhage, infection, post-operative positioning complications
Exudative RD secondary to ARMD or diabetic ret tx
anti-VEGF injection
