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OD3 (S1&2) > DIS - Vitreous Retinal Traction - Week 8 > Flashcards

DIS - Vitreous Retinal Traction - Week 8 Flashcards

1
Q

In what four dieases does the vitreoretinal interface play a role in and what technique is extremely useful in evaluating these diseases?

A

Vitreomacular traction syndrome
Epiretinal membranes
Macular holes
Schisis
-OCT useful for evaluation

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2
Q

What is the pathophysiology of macular oedema (2)?

A

Due to the breakdown of the blood-retina barrier
Fluid leaks into the retina

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3
Q

List 11 associations or causes of macular oedema.

A

Diabetic retinopathy
Branch retinal vein occlusion
Retinitis pigmentosa
Chronic uveitis
Intracular surgery
Epiretinal membrane
Choroidal tumours
Perifoveal telangiectasis
Retinal detachment
Idiopathic
Latanoprost

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4
Q

What kind of vision loss tends to occur with macular oedema? What happens to vision after the oedema is absorbed?

A

Mild VA loss, often 6/12 to 6/19
Vision recovers as oedema absorbed

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5
Q

Can macular oedema cause permanent vision loss?

A

Chronic oedema can

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6
Q

Is pain involved with vision loss in macular oedema?

A

No

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7
Q

How does the fovea/macula appear with macular oedema (4)?

A

Indistinct
Thinkened
Loss of foveal reflex
Exudate

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8
Q

What angiography pattern can be indiciative of macular oedema?

A

Petallic hyperfluorescence

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9
Q

How does macular oedema appear on an OCT scan (2)?

A

Retinal thickening and fluid accumulation

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10
Q

What is a differential diagnosis for macular oedema?

A

Retinoschisis

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11
Q

List four possible outcomes/complications of macular oedema.

A

None
-spontaneous absorption
Macular hole
Epiretinal membrane
Outer retinal and RPE atrophy
-permanent visiond loss

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12
Q

What is the management of macular oedema (3)?

A

identify cause
OCT/fluorescein angiography
Treat primary condition

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13
Q

What is the treatment of macular oedema secondary to irvine-gass syndrome or uveitis (3)?

A

Corticosteroids
NSAIDs
Carbonic anhydrase inhibitors

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14
Q

What is the treatment of macular oedema secondary to diabetes (2)? Comment on the effectiveness.

A

Anti-VEGF
-good clinicald effectiveness
Steroids
-mixed results, associated with cataract/IOP spike

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15
Q

List two surgical treatment options for macular oedema. List a disease each one is indicated for.

A

Scatter /grid photocoagulation (diabetic retinoapthy, C/BRVO)
Pars planar vitrectomy (uveitis)

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16
Q

What is an epiretinal membrane and where can it be found? What is it additionally known as (2)?

A

Avascular, fibrocellular (glial) membranes on the surface of the retina
-cellophane maculopathy
-preretinal fibrosis

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17
Q

Are epiretinal membranes more common in younger or older patients?

A

Older, >70yoa

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18
Q

List four ocular-related secondary causes of epiretinal membranes.

A

Posteroir vitreous detachment
Vascular retinopathy
Ocular inflammation
Diabetic retinopathy

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19
Q

List four ocular related iatrogenic causes of epiretinal membranes.

A

Cataract
Retinal detachment repair
Laser
Cryo

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20
Q

Are there systemic causes of epiretinal membranes? Explain (2).

A

It is possible
Bilateral in 31% of cases
Unaffected eye of an affected individual has 2.5x greater risk than a single eye of an unaffected individuals

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21
Q

List four symptoms of epiretinal membranes.

A

Mild blurring and/or metamorphopsia
Micropsia
Macropsia
Monocular diplopia

22
Q

Is progression fast or slow with epiretinal membranes?

A

Static/slow progression

23
Q

What is vision generally like with epiretinal membranes (VA and percentage)?

A

80% have acuity better than 6/15

24
Q

Describe grade 0 to 2 for epiretinal membranes.

A

0 - translucent membrane, no retinal distortion
1 - irregular wrinkling of the inner retinal surface and retinal distortion
2 - opaque, thick membrane, macular pucker

25
Q

What are the two types of attachments of epiretinal membranes and what percentage are idiopathic/secondary?

A

Focal or global
50% idiopathic membranes are focal
20% of secondary membrane are focal

26
Q

What are four things you may see on an OCT scan of an epiretinal membrane?

A

Presence/absence
Macular thickening
Macular oedema
Traction

27
Q

List three differential diagnoses for epiretinal membranes.

A

Retinal detachment
Retinal vacular occlusion disease
Macular oedema

28
Q

What is a complication of epiretinal membranes?

A

Vitreomacular traction syndrome

29
Q

Describe what occurs in vitreomacular traction syndrome. What might this cause? What region is usually hyper-reflective and thickened on OCT?

A

Vitreous remains attached to the macula and ONH
Focal vitreofoveolar adhesion may cause cystoid macular oedema
Posterior hyaloid is usually hyper-reflective/thickened on OCT

30
Q

What can be done to improve VA with vitreomacular traction syndrome?

A

Surgical (or spontaneous) separation of the vitreous from the fovea, which usually improves VA

31
Q

What is the management of epiretinal membranes (3)?

A

Exclude other causes
Mild/static cases usually not treated
-25% regresses over 5 years
-refer if symptoms are significant

32
Q

Is complete recovery of VA following surgery for epiretinal membranes common or rare?

A

Rare, but usually improves still

33
Q

What does surgery for epiretinal membranes involve?

A

Vitrectomy then removal of the membrane

34
Q

List three intra-operative complications of surgery for epiretinal membranes.

A

Vitreous haemorrhage
Retinal surface damage
Peripheral retinal breaks

35
Q

List three post-operative complications of surgery for epiretinal membranes.

A

Recurrence
Cataract
Retinal detachment

36
Q

What is thought to be the primary underlying cause for idiopathic macular holes?

A

Anteroposterior and tangential vitrous traction on the fovea

37
Q

List 7 causes/associationd of macular holes.

A

Idiopathic
Myopic degeneration
Vitrous traction/separation/detachment
Trauma
Macular oedema
Epiretinal membrane
Solar retinopathy

38
Q

Are macular holes typically uni- or bilateral?

A

Unilateral

39
Q

List three visual disturbances caused by macular holes. When are these disturbances evident?

A

Blurred central vision and/or metamorphopsia
Central scotoma (Amsler)
-may only be discovered if the other eye is covered

40
Q

What does the visual acuity of an eye with a macular hole depend on (2)?

A

Size and shape (6/7.5 to 6/120)

41
Q

How do macular holes appear on a fundus exam and what size?

A

Well-defined round/oval lesion 1/3 DD at the macula with yellow/white deposits in the base

42
Q

What can be seen suspended over a macular hole?

A

Semitranslucent tissue called pseudo-operculum

43
Q

Can OCT easily identify different types of macular holes or are they indistinguishable?

A

Can easily identify different types

44
Q

Describe the watzke-allen test for macular holes and what a positive result would be. Ises narrowing or distortion diagnostic?

A

Using a fundus lens and placing a narrow vertical slit through the fovea
A positive test is when patients detect a break in the bar of light that they perceive
Narrowing or distortion is not diagnostic - interpret with caution

45
Q

What happens to pathology the smaller the vitreous attachment?

A

The smaller the vitrous attachment, the greater the force exerted, and the greater the pathology

46
Q

What does more reflectivity of the prefoveal opacity indicate for surgical closure?

A

The higher the reflectivity, the lower the chance of surgical closure

47
Q

What is the management for macular holes ?

A

Amsler for monitoring the other eye
OCT, distinguish type, check other eye
Fluorescein angiography
Referral for surgery

48
Q

What two differential diagnoses for macular holes can fluorescein angiography be used to rule out?

A

Macular oedema
Choroidal neovascularisation

49
Q

What is the surgical procedure for macular holes (3)? Is it generally successful? What VA outcomes would you expect?

A

Removal of epiretinal membranes, vitrectomy, following by face-down gas tamponade
>80% success rate
>50% improve VA by 2+ lines

50
Q

What diameter is considered a large macular hole?

A

> 400um

51
Q

Describe the inverted ILM technique and note which type of macular holes this technique is used for and why.

A

A remnant of the ILM is left attached to the margins of the hole and inverted to cover the macular hole
Prevents post-operative flat-open appearance and improves function VA outcomes
Used for large holes

OD3 (S1&2) (114 decks)

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