Degeneration of Fundus

Question 1

Myopic Macular Degeneration signs

Answer 1

Tessellated fundus, Diffused/patchy choroidal atrophy, lacquer cracks, choroidal neovascularisation, macular atrophy, scleral crescent, fuchs spot is raised

Question 2

Myopic Macular Degeneration complications

Answer 2

Posterior staphylomas, foveal retinoschisis, cataract, glaucoma, rhegmatogenous RD

Question 3

Myopic Macular Degeneration Management

Answer 3

Monitor progression and complications, refer to an ophthalmologist for any sight-threatening complications

Question 4

Risk factors of AMD

Answer 4

Age >50, females, Caucasians, positive family history, smoking, obesity, hypertension, prolonged UV exposure

Question 5

Formation of drusens

Answer 5

Accumulation of lipofuscin between Bruch’s membrane and RPE, depigmentation, and hyperpigmentation of RPE

Question 6

Dry AMD signs and symptoms

Answer 6

Signs: Focal hyperpigmentation or atrophy of the RPE with drusen
Sharply circumscribed, areas of RPE atrophy associated with loss of choriocapillaries
Enlargement of atrophic areas

Symptoms: Gradual impairment of vision

Question 7

Dry AMD management

Answer 7

Treatment not possible, high dose of multivitamins and antioxidant supplements, eat a nutritious diet, protect against UV, self-monitor with Amsler grid

Question 8

Wet AMD Pathogenesis

Answer 8

Wet AMD is caused by choroidal neovascularisation which grows through defects in Bruch’s membrane. CNV is due to the imbalance between vascular endothelial growth factors and pigment epithelial derived factor. initial visual loss is due to leakage of blood and serum under neurosensory retina. Accumulation of fluid results in loss of photoreceptors and form a scar and permanent vision loss

Question 9

Wet AMD signs and symptoms

Answer 9

Si: Hard exudates, cystoid macular oedema, intra and sub retinal haemorrhages
S: Metamorphopsia, positive scotoma, rapid blurring of central vision

Question 10

Wet AMD signs in chronological order

Answer 10

Haemorrhagic pigment epitheliul detachment, vitreous haemorrhage, subretinal scarring, massive subretinal exudation

Question 11

Wet AMD management

Answer 11

Refer to ophthalmologist for laser photocoagulation, photodynamic therapy, intravitreal anti-VEGF agents

Question 12

Macular Hole pathogenesis

Answer 12

Abnormal vitreo-foveolar traction

Question 13

Macular Hole stages

Answer 13

Stage 1a: flattening of foveal depression with xanopthyll
Stage 1b: Yellow ring with metamorphopsia and VA drop
Stage 2: small full-thickness hole less then <400um
Stage 3: full size macular hole more than >400um
Stage 4: Presence of Weiss Ring is a sign of PVD

Question 14

Macular Hole diagnostic test and management

Answer 14

Watze-Allen test and OCT

M: refer to ophthalmologist where surgery is indicated for stage 2 and above with VA worse than 6/9

Question 15

Central Serous Retinopathy pathogenesis

Answer 15

Disorder of the blood-retinal barrier with a localised detachment of the neurosensory retina at the macula secondary to focal RPE changes

Question 16

Central Serous Retinopathy signs

Answer 16

Accumulation of fluid in the subretinal space, round or oval detachment of the neurosensory retina at macula

Question 17

Central Serous Retinopathy management

Answer 17

Refer for monitoring, laser photocoagulation

Question 18

Cystoid Macular Oedema pathogenesis

Answer 18

Accumulation of fluid between outer plexiform layer and inner nuclear layersw/ formation of fluid filled cyst liked changes

Question 19

Cystoid Macular Oedema signs

Answer 19

Loss of foveal depression, retinal thickening, multiple cystoid areas

Question 20

Cystoid Macular Oedema management

Answer 20

Refer to ophthalmologist for steroids and NSAIDS

Question 21

Epiretinal Membrane pathogenesis

Answer 21

Proliferation of glial cells that have gained access of the retinal surface through breaks in the inner limiting membrane

Question 22

Epiretinal Membrane signs

Answer 22

Irregular light reflex, sheen at macula, epiretinal membrane is translucent, macula pucker

Question 23

Epiretinal Membrane management

Answer 23

No treatment if VA <6/12, refer to ophthalmologist for vitrectomy and membrane peeling