DIS - Macular Diseases III: Non-Age Related - Week 2 Flashcards
List 7 examples of non-AMD macular diseases.
Central serous chorio-retinopathy
Angioid streaks
Myopic macula degeneration
Drug toxicity
Cystoid macular oedema
Blunt trauma
Phototoxicity
List an example of drug toxicity causing macula disease.
Chloroquine/hydroxychloroquine
What is the histopathology od central serous chorioretinopathy (3)?
Subretinal fluid with RPE thinning
There may or may not be choroidal thickening
Is the choroid visible when doing OCT on central serous chorioretinopathy?
Yes, with enhanced depth imaging
Why does sub-retinal fluid accumulate in central serous chorioretinopathy (3)?
Breakdown of the RPE blood retinal barrier and RPE pumps
This promotes fluid accumulaion in the sub-retinal space over the macula
What detachment occurs with central serous chorioretinopathy and why?
Accumulation of fluid under photoreceptors
results in retinal elevation at the macula to
form a serous retinal detachment
Why does fluid accumulate only at the macula in central serous chorioretinopathy?
Poorly understood why
What kind of vision loss can you expect from central serous chorioretinopathy? Is it sudden or chronic? Is pain involved?
Sudden, painless, central vision loss
Typical VA is 6/9 to 6/36
What kind of visual defect would you expect with central serous chorioretinopathy?
Relative central/paracentral scotoma
How does central serous chorioretinopathy affect photostress test?
Prolonged
What happens to contrast sensitivity with central serous chorioretinopathy?
Loss
Is colour vision affected with central serous chorioretinopathy?
Loss of colour saturation
What ametropic shift is induced by central serous chorioretinopathy?
Hyperopic shift
What test is essential for management and differential diagnosis of central serous chorioretinopathy?
OCT
What kind of personalities can be a risk factor for central serous chorioretinopathy? What gender and age?
Young, anxious males
Type 3 AAA personalities
Is steroid use a risk factor for or against central serous chorioretinopathy?
Risk factor for
How does central serous chorioretinopathy appear on funduscopy? Is it easy to see?
Oval/round lesion at the macula - like a swelling or bubble
Hard to see
How wide is the lesion with central serous chorioretinopathy typically?
1-4DD
Is the foveal reflex present with central serous chorioretinopathy?
No
Is a choroidal neovascular membrane present with central serous chorioretinopathy? How does this affect treatment?
It is absent
-aVEGF is limited for central serous chorioretinopathy
List the two types of central serous chorioretinopathy. Give approximate proportion of cases for each.
Local serous detachment (25%)
Diffuse retinal pigment epitheliopathy (75%)
What distinct sign can be seen in late phase angiography with serous detachment central serous chorioretinopathy?
Smoke stack
How does serous detachment central serous chorioretinopathy appear on fundus autofluorescence?
A localised lesion with a prominent bright halo
What choroid thickness would you expect with serous detachment central serous chorioretinopathy on OCT?
Normal choroid thickness <300um
What is the prognosis of serous detachment central serous chorioretinopathy?What can happen with recurrence?
Usually good but can lead to diffuse retinal pigment epitheliopathy with recurrence
What is the treatment for serous detachment central serous chorioretinopathy (2)?
Usually untreated
-if needed for a longstanding case, treat with a spot laser at the leak
How is the location of lesions different in diffuse retinal pigment epitheliopathy compared to serous detachment central serous chorioretinopathy?
Diffuse retinal pigment epitheliopathy can involve para-macular locations
Is diffuse retinal pigment epitheliopathy typically short- or long-lived? Does it recur often?
Can be short-lived by recurrences often
What two tests are needed for diagnosis?
FAF or OCT
What can be seen on FAF with diffuse retinal pigment epitheliopathy?
Shows a long tail with RPE dropout
How does diffuse retinal pigment epitheliopathy often appear on OCT?
Focal RPE detachment
-pigmentary epithelial detachment
What choroid thickness would you expect on OCT with diffuse retinal pigment epitheliopathy?
Thicker than normal >300um
What is the treatment for diffuse retinal pigment epitheliopathy? Is it successful?
Spot laser - limited success but needed for local RPE detachment
Would you suspect the fellow eye in unilateral diffuse retinal pigment epitheliopathy?
It can be abnormal
What may chronic diffuse retinal pigment epitheliopathy lead to and why?
Possible that chronic choroidal thickening in CSCR leads to permanent loss and focal choroidal excavation
List six differential diagnoses for central serous chorioretinopathy.
AMD
Optic pit related serous elevation
Retinal detachment with macular involvement
Pigmentary epithelial detachment
Choroidal tumour/inflammation
Systemic disease
List two examples of systemic diseases that may be a differential diagnosis for central serous chorioretinopathy.
Hypertension
Renal failure