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OD3 (S1&2) > DIS - Macular Diseases III: Non-Age Related - Week 2 > Flashcards

DIS - Macular Diseases III: Non-Age Related - Week 2 Flashcards

1
Q

List 7 examples of non-AMD macular diseases.

A

Central serous chorio-retinopathy
Angioid streaks
Myopic macula degeneration
Drug toxicity
Cystoid macular oedema
Blunt trauma
Phototoxicity

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2
Q

List an example of drug toxicity causing macula disease.

A

Chloroquine/hydroxychloroquine

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3
Q

What is the histopathology od central serous chorioretinopathy (3)?

A

Subretinal fluid with RPE thinning
There may or may not be choroidal thickening

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4
Q

Is the choroid visible when doing OCT on central serous chorioretinopathy?

A

Yes, with enhanced depth imaging

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5
Q

Why does sub-retinal fluid accumulate in central serous chorioretinopathy (3)?

A

Breakdown of the RPE blood retinal barrier and RPE pumps
This promotes fluid accumulaion in the sub-retinal space over the macula

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6
Q

What detachment occurs with central serous chorioretinopathy and why?

A

Accumulation of fluid under photoreceptors
results in retinal elevation at the macula to
form a serous retinal detachment

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7
Q

Why does fluid accumulate only at the macula in central serous chorioretinopathy?

A

Poorly understood why

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8
Q

What kind of vision loss can you expect from central serous chorioretinopathy? Is it sudden or chronic? Is pain involved?

A

Sudden, painless, central vision loss
Typical VA is 6/9 to 6/36

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9
Q

What kind of visual defect would you expect with central serous chorioretinopathy?

A

Relative central/paracentral scotoma

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10
Q

How does central serous chorioretinopathy affect photostress test?

A

Prolonged

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11
Q

What happens to contrast sensitivity with central serous chorioretinopathy?

A

Loss

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12
Q

Is colour vision affected with central serous chorioretinopathy?

A

Loss of colour saturation

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13
Q

What ametropic shift is induced by central serous chorioretinopathy?

A

Hyperopic shift

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14
Q

What test is essential for management and differential diagnosis of central serous chorioretinopathy?

A

OCT

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15
Q

What kind of personalities can be a risk factor for central serous chorioretinopathy? What gender and age?

A

Young, anxious males
Type 3 AAA personalities

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16
Q

Is steroid use a risk factor for or against central serous chorioretinopathy?

A

Risk factor for

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17
Q

How does central serous chorioretinopathy appear on funduscopy? Is it easy to see?

A

Oval/round lesion at the macula - like a swelling or bubble
Hard to see

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18
Q

How wide is the lesion with central serous chorioretinopathy typically?

A

1-4DD

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19
Q

Is the foveal reflex present with central serous chorioretinopathy?

A

No

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20
Q

Is a choroidal neovascular membrane present with central serous chorioretinopathy? How does this affect treatment?

A

It is absent
-aVEGF is limited for central serous chorioretinopathy

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21
Q

List the two types of central serous chorioretinopathy. Give approximate proportion of cases for each.

A

Local serous detachment (25%)
Diffuse retinal pigment epitheliopathy (75%)

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22
Q

What distinct sign can be seen in late phase angiography with serous detachment central serous chorioretinopathy?

A

Smoke stack

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23
Q

How does serous detachment central serous chorioretinopathy appear on fundus autofluorescence?

A

A localised lesion with a prominent bright halo

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24
Q

What choroid thickness would you expect with serous detachment central serous chorioretinopathy on OCT?

A

Normal choroid thickness <300um

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25
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
26
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
27
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
28
Is diffuse retinal pigment epitheliopathy typically short- or long-lived? Does it recur often?
Can be short-lived by recurrences often
29
What two tests are needed for diagnosis?
FAF or OCT
30
What can be seen on FAF with diffuse retinal pigment epitheliopathy?
Shows a long tail with RPE dropout
31
How does diffuse retinal pigment epitheliopathy often appear on OCT?
Focal RPE detachment -pigmentary epithelial detachment
32
What choroid thickness would you expect on OCT with diffuse retinal pigment epitheliopathy?
Thicker than normal >300um
33
What is the treatment for diffuse retinal pigment epitheliopathy? Is it successful?
Spot laser - limited success but needed for local RPE detachment
34
Would you suspect the fellow eye in unilateral diffuse retinal pigment epitheliopathy?
It can be abnormal
35
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
36
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
37
List two examples of systemic diseases that may be a differential diagnosis for central serous chorioretinopathy.
Hypertension Renal failure
38
Is it common or rare to develop a choroidal neovascular membrane with central serous chorioretinopathy? Is it more or less likely to occur with pigmentary epithelial detachment? What about if laser is used for treatment?
Small number develop CNVM (1-3% rare) - more likely with PED or laser
39
Is it more or less likely to develop a choroidal neovascular membrane with central serous chorioretinopathy if there is also focal choroidal excavation?
More likely - can predispose
40
Can all of VA, contrast sensitivity, and colour vision be expected to return to normal after recovery from central serous chorioretinopathy?
VA may, but CS and CV may not always be normal
41
List three essential components of assessing central serous chorioretinopathy.
Dilated fundus exam Colour fundus photography Choroidal OCT
42
What four visual parameters should be recorded when assessing central serous chorioretinopathy?
VA Contrast sensitivity Colour vision Central VF 10-2/macula pattern
43
When does vision typically improve with central serous chorioretinopathy?
2-3 weeks
44
When should cases of central serous chorioretinopathy be reviewed? After what period of time should referral be made if persistent and for what?
Every 4 weeks -refer if not resolved after 12 weeks for FAF and OCTa
45
If a referral is made for a persistent central serous chorioretinopathy, what happens (3)?
OCTa and FAF Observed by the ophthalmologist for up to 26 weeks for late recovery -laser grid in the region of the DRPE
46
If the central serous chorioretinopathy is very diffuse, what should you do (2)?
Refer for photodynamic therapy and anti-corticoids
47
What are angioid streaks?
Cracks in thickened bruchs membrane
48
What colour do angioid streaks have? What do they look like?
Orange/brown colour -look like dark blood vessels
49
What region of the retina are angioid streaks most obvious? What happens to them as you move towards the periphery?
Around the disc Thins out/disappears towards the periphery
50
What do you expect to see on OCT of angioid streaks?
Cracks/openings in bruchs membrane with in-filling of tissue
51
What is the ISe like over angioid streaks?
Faded or lost
52
What are the symptoms of angioid streaks (2)?
Asymptomatic -unless CNVM
53
What happens to the risk of CNVM with angioid streaks with age?
Increases
54
Can angioid streaks cause haemorrhage or exudation?
Yes
55
Why is OCT essential for angioid streaks?
To detect subretinal fluid - CNVM
56
What is the management for angioid streaks (2)? What about if CNVM is present?
Conservative reviews Refer for aVEGF if CNVM is present Safety glasses for sport as the retina is fragile
57
What kind of disordrrs are angioid streaks sometimes associated with?
Systemic collagen disorders -pseudoxanthoma elasticum -pagets disease -sickle cell disease -ehlers-danlos syndrom
58
What are most ases of angioid streaks due to?
Idiopathic
59
What is there a very high risk of with angioid streaks (2) and from what?
High risk of choroidal rupture and/or retinal haemorrhage from milk blunt trauma
60
List three manifestations of myopic macular degeneration.
Diffuse thinning Lacquer cracks CNVM
61
Why may CNVM appear with myopic macular degeneration (3)?
Stretched bruchs membrane may result in weaknesses that crack and produce lacquer cracks Allows ingrowth of CNVM
62
What is fuchs spot?
Haemorrhage and pigment proliferation with ingrowth of CNVM at the macula
63
What percentage of high myopes have myopic macular degeneration?
10%
64
What ocular component does the drug quinine have affinity for?
Melanin in the RPE
65
What poses less risk, plaquenil or quinine?
Quinine
66
What is the mechanism behind drug toxicity with quinine?
Unclear
67
What is a sign of quinine maculopathy, how does it appear, and what is it best seen with?
Parafoveal granularity of the RPE -gives central zone of hyperpigmentation with a hypo-ring -bullseye appearance Best seen with FAF
68
In what three ways does quinine maculopathy affect vision? Which is affected late?
Loss of sensitivity Abnormal colour vision VA loss -affected late
69
Is body fat a risk factor for or against quinine maculopathy?
Risk factor for
70
Is age a risk factor for quinine maculopathy?
Yes >60
71
What six things (including tests) should patients have done before taking quinine for monitoring maculopathy?
VA (including contrast) DFE with photos and OCT Colour vision Central VF 10-2 Home self-monitoring
72
What is the followup schedule (3) for monitoring quinine maculopathy (patients just starting the drug)?
5 years 2 years -then yearly for high risk patients according to dose, age, body fat
73
What should you do if macular changes are evident when monitoring patients for quinine maculopathy?
Refer to their medical practitioner
74
What is cystoid macular oedema and in what retinal layers (2)?
Leakage from retinal capillaries causing oedema and formation of cysts in the OPL/INL around the fovea
75
What three conditions is cystoid macular oedema often secondary to?
Diabetes BRVO Inflammation (uveitis)
76
What macular thickness do you expect on OCT of cystoid macular oedema?
>350 central foveal thickness
77
List and describe the two possible mechanisms f cystoid macular oedema.
Active -inflammatory damage to capillary endothelial cells causing leakage Passive -increased venous back-pressure causing an inflammatory overlay
78
What two cytokines are involved in the passive mechanism of cystoid macular oedema?
Increase in IL-6 and TNFalpha
79
What appearance does cystoic macular oedema have on fluorescein angiography and in what phase?
Cysts in a radiating pattern like a flower petal -late phase
80
List 10 causes/associations of cystoid macular oedema.
Diabetes Retinal vein occlusions Anterior uveitis Adrenaline usage Retinitis pigmentosa Any intraocular surgery -cataract, vitrectomy, scleral buckling, keratoplasty Epiretinal membranes Malignant choroidal melanoma Retinal detachment Idiopathic
81
What kind of VA loss would you expect from cystoic macular oedema?
Mild -6/12 to 6/19
82
Does cystoid macular oedema affect contrast sensitivity?
Yes
83
Is VA loss with cystoid macular oedema chronic or acute? Is VA recovered as the oedema is absorbed?
Chronic VA recovered as oedema absorbed
84
What can chronic cystoid macular oedema result in? Can this be reversed? What has benefit and is it small or large?
Permanent neuronal damage -no or incomplete recovery of vision -aVEGF medication has small benefit, NSAIDs
85
List four possible sequelae of cystoid macular oedema and why they can occur if applicable.
None Lamellar retinal hole -rupture of a cyst Epiretinal membrane -cellophane rinopathy Outer retinal and RPE atrophy -permanent visual loss in persistent leak
86
What should be done as a baseline for cystoid macular oedema (4)?
Slit-lamp DFE CFP OCT
87
What is the treatment for cystoid macular oedema if central foveal thickness is >350um (4)?
NSAIDs Intravitreal steroid aVEGF Scatter or grid photocoagulation around the macula -diabetes/RVO
88
If blunt trauma has occurred, when should you refer for ophthalmological examination (3)?
If you see: -vitreous haemorrhage -commotio retinae -choroidal split/rupture
89
What is commotio retinae (4)? What can it lead to?
Glial swelling Retinal thickening Loss of foveal pit nRD - appears white -can lead to traumatic macular hole
90
What does excessive exposure to light cause at the retina?
Excessive oxidative damage
91
What does blue light tend to do to the retina?
Cause formation of free radicals
92
What does infra-red light tend to do to the retina? How does it appear?
Gives heating/burning of retinal tissue -large atrophic zone with pigmented lesion
93
List three possible causes of phototoxicity.
Solar retinopathy Long exposure to operating microscopes Lasers
94
What is the treatment for phototoxicity?
None available

OD3 (S1&2) (114 decks)

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