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II. Posterior Segment Disease > Final > Flashcards

Final Flashcards

1
Q

What are the possible mechanisms to treat the hypoxia of Bruch’s/RPE in macular degeneration?

A
  1. lose weight

2. eat healthy

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2
Q

What is an iris tuft capable of producing?

A

a hyphema if pops

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3
Q

What is the size of small drusen? 1. Medium drusen? 2. Large drusen? 3

A
  1. less than 63 microns (1/2 retinal vein)
  2. between 63 and 125 microns
  3. more than 125 microns
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4
Q

What is the study that showed that grid laser has a modest effect on macular edema in BRVO?

A

BVOS

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5
Q

What is the temporary loss of vision in one eye during a TIA called? 1. What other condition can lead to this? 2

A
  1. amaurosis fugax (transient monocular blindness)

2. migrane headaches

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6
Q

What are the microvascular problems associated with diabetes (with examples)?

A
  1. kidney (nephropathy)
  2. nerves (neuropathy)
  3. ocular involvement (retinopathy)
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7
Q

What are the more advanced changes in the retina due to chronic hypertension?

A
  1. cotton wool spots
  2. flame hemorrhages
  3. intraretinal macular edema, optic disc edema
  4. macular star hard exudates
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8
Q

What is the study that showed that patients with clinically significant macular edema from NPDR usually benefit from laser photocoagulation?

A

ETDRS

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9
Q

For a BRAO, what do the emboli consist of?

A
  1. cholesterol
  2. calcium
  3. crystals of drug
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10
Q

What is the study that showed the significance of PRP for neovascularization in diabetic retinopathy?

A

diabetic retinopathy study (DRS)

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11
Q

What is the study that showed that anti-VEGF intravitreal injections may help with macular edema in BRVO, making it the standard of care?

A

BRAVO study

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12
Q

What is the study that showed that intravitreal steroids can help with macular edema for CRVO?

A

SCORE study

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13
Q

What is different about the appearance and presentation of CRAO compared to BRAO?

A
  1. complete loss of vision
  2. retina is completely white except for a cherry red spot over fovea (diff blood supply)
  3. veins distended and segmented (boxcarring)
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14
Q

What are the possible mechanisms to treat the choroidal neovascularization in macular degeneration?

A
  1. laser
  2. PDT (with kenalog)
  3. intra-vitreal anti-VEGF meds
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15
Q

What is the type of diabetes that is not due to insulin resistance and can initially be controlled with meal planning but insulin dependency gradually occurs?

A

latent autoimmune diabetes in adults (LADA)

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16
Q

What are the signs and symptoms of a transient ischemic attack?

A
  1. sudden numbness or weakness of face, arm, or leg on one side of the body
  2. temporary difficulty understanding speech
  3. temporary (up to 2 hours) loss of vision in one eye
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17
Q

How long until permanent damage is done to the retinal following a BRAO? 1. What layers of the retina does the anoxia affect?

A
  1. 105 min
  2. nerve fiber layer
  3. ganglion cell layer
  4. inner plexiform layer
  5. inner nuclear layer
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18
Q

What is the idea that over the first 18 months there may be worsening of the diabetic retinopathy with controlling of HbA1C compared to non-intensive/conventional control?

A

normal glycemic re-entry

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19
Q

What are the common signs and symptoms of diabetes mellitus?

A
  1. refractive changes
  2. mild weight loss, fatigue, weakness
  3. the triad: polyuria, polydipsia, polyphagia
  4. infection
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20
Q

What is the type of choroidal neovascular membrane that has poorly demarcated hyperfluorescence on FANG and is sub-RPE? 1. Is it more or less common than the other kind? 2

A
  1. occult CNVM

2. more common

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21
Q

What are the treatments in order from best to worst according to the DRCR study used for DME?

A
  1. anti-VEGF meds
  2. intravitreal tiamcinolone acetonide
  3. focal or grid laser photocoagulation
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22
Q

What were the supplements used for the AREDS study?

A
  1. vitamin C
  2. vitamin E
  3. Beta-carotene
  4. zinc
  5. copper
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23
Q

What are the top reasons in order for iris neovascularization?

A
  1. diabetic retinopathy
  2. CRVO
  3. carotid occlusive disease
24
Q

What is the best way to detect macular edema besides OCT and FANG?

A

Volk area centalis (non-mirrored portion)

25
Q

What is the study that showed that intensive blood sugar control slows diabetic retinopathy progression?

A

diabetes control and complications trial (DCCT)

26
Q

Is soft drusen or hard drusen a bad prognostic sign?

A

soft drusen

27
Q

What is it called when a blood vessel to the brain is compromised by hemorrhage, clot or embolus?

28
Q

Where is most of the blood located during a BRVO?

A

nerve fiber layer or below

29
Q

What are the possible mechanisms to treat the inflammation and free radical formation in macular degeneration?

A
  1. supplements

2. UV protection

30
Q

What is the vein occlusion that has only one hemisphere affected called? 1. What is the treatment similar to? 2

A
  1. hemicentral retinal vein occlusion

2. CRVO (refer)

31
Q

What percentage of CRVO’s develop neovascular glaucoma? 1. What percentage of ischemic CRVO’s? 2

A
  1. 14-20%

2. 60%

32
Q

What is the function of insulin in the body?

A

key allowing glucose to get into cells for energy

33
Q

What were the conclusions from the central vein occlusion study (CVOS)?

A
  1. grid laser not helpful for macular edema
  2. PRP for nonischemic CRVO should wait until NVI develops before performing
  3. eyes with extensive hemes = ischemic
34
Q

What are the anti-VEGF meds used for the management of BRVO?

A
  1. Lucentis
  2. avastin
  3. Eyelia
35
Q

What percentage of strokes are preceded by transient ischemic attacks? 1. How long do these usually last? 2

A
  1. 10%

2. usually under 5 min but can be longer

36
Q

What is the study that showed that anti-VEGF intravitreal injections may help with macular edema in CRVO, making it the standard of care?

A

CRUISE study

37
Q

If you are ever unsure changes in the macula (from clinical examination and/or reduced VA) what must you do?

A
  1. run OCT and/or

2. refer to ophthalmology

38
Q

Where in the retina are the veins most often associated with BRVO? 1. Why? 2

A
  1. superior temporal

2. more AV crossings

39
Q

What is the leading cause of new blindness in the U.S. for people between 20 and 74?

A

diabetic retinopathy

40
Q

What are the differences between neo and IRMA?

A

IRMA is:

  1. deeper
  2. blurrier edges
  3. burgundy (not as red)
  4. not at disk
  5. shorter period of DM or poor control
41
Q

What are the blood work tests that need to be performed for someone that has a BRVO?

A
  1. blood pressure
  2. fasting blood sugar or HbA1C
  3. lipid profile
  4. platelet count
  5. CBC with differential
  6. ESR or C-reactive protein
42
Q

What disease of the eye is commonly associated with CRVO?

A

primary open angle glaucoma

43
Q

What stage does arteriosclerotic retinopathy not get to?

A

leakage or occlusion (stay within mild hypertensive retinopathy)

44
Q

What are the two reasons for loss of vision in diabetic retinopathy?

A
  1. macular edema

2. retinal hypoxia with neovascular nets

45
Q

What is the genesis of diabetic retinopathy?

A
  1. losses of pericytes in BV walls especially during fluctuations in blood sugar
  2. changes in capillary walls lead to focal development of microaneurysms, vascular loops, and dilated capillaries
46
Q

Are collaterals crossing the horizontal raphe a good or bad sign for a BRVO?

A

good sign because old BRVO

47
Q

What are the top reasons in order for retinal neovascularization?

A
  1. diabetic retinopathy

2. BRVO

48
Q

What is the study that showed the significance of vitrectomy for vitreous involvement in diabetic retinopathy?

A

diabetic retinopathy vitrectomy study (DRVS)

49
Q

What is the type of choroidal neovascular membrane that has well demarcated hyperfluorescence on FANG and is subretinal? 1. Is it more or less common than the other kind? 2

A
  1. classic CNVM

2. less common

50
Q

What are the macrovascular problems associated with diabetes (with examples)?

A
  1. coronary artery disease (angina, MI, heart failure)
  2. peripheral vascular disease (gangrene and non-healing foot wounds)
  3. cerebro-vascular disease (stroke, TIA’s)
51
Q

What are BRAO often associated with that may have happened in the past to the patient?

A
  1. amaurosis fugax

2. TIA

52
Q

What quadrant of the retina is usually affected by a BRAO?

A

upper temporal

53
Q

What are the conditions in which you should always check a persons blood sugar?

A
  1. DM symptoms
  2. refractive error or visual changes suggestive of DM
  3. retinopathy
  4. obesity and strong family Hx
  5. Hx of DM
54
Q

What should smokers avoid because of the increased risk of lung cancer?

A

beta carotene

55
Q

What can cause complete vision loss in a CRVO?

A
  1. retinal neovascularization

2. neovascular glaucoma secondary to iris and angle neo (90-day or 100-day glaucoma)

56
Q

What is the study that confirmed that grid laser is still the standard of care for BRVO over steroids?

A

SCORE study

57
Q

What are CRVO’s likely to get in the retina?

A

collaterals at the optic nerve head (shunts)

II. Posterior Segment Disease (3 decks)

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