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Ocular Disease II > Glaucoma: Vitreous: Dr. Helmuth Lecture > Flashcards

Glaucoma: Vitreous: Dr. Helmuth Lecture Flashcards

1
Q

Anatomy

  1. Makes up what % of the eye?
  2. Vitreous Base: Extends about how far Anterior/Posterior to the what?
  3. What creates a STRONG ADHESION?
  4. Lens and Vitreous are JUXTAPOSED after about how many years?
  5. Peripapillary Adhesion around Optic Disc: What happens with age?
  6. Annular Ring of Attachment is what size in Diameter?
  7. Also attached to what?**
  8. Rest of Vitreous not firmly Attached. Thought to be what?
A
  1. 80%
  2. 2mm anterior/posterior to Ora Serrata and about the same into the vitreous itself
  3. Vitreal fibers embedded into Epithelium of CB and ILM of peripheral retina
  4. After about 35 years
  5. Decreases w/Age
  6. 3-4 mm in diameter
  7. to Retinal BVs by fine strands that penetrate the ILM to branch and *SURROUND larger retinal BVs
  8. Like Glue…joining vitreous and ILM (filled w/Sticky Stuff)
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2
Q

Vitreous Cortex

  1. Vitreous Cortex = ?
  2. Anterior Cortex (anterior to what)
  3. Posterior Cortex (Posterior to what?
A
  1. HYALOID SURFACE = Outer Zone
  2. Anterior to the Base
  3. Posterior to the Base
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3
Q

Intermediate Zone

  1. What canal?
  2. Vitreous is what % of water?
  3. Solutes include what?
  4. Collagen? HIGHEST WHERE?
  5. Individual Fibers can’t be seen, but what can be?
A
  1. Cloquet’s Canal
  2. 99%
  3. Hyaluronic Acid
  4. Highest in BASE, then Posterior Cortex
  5. Pattern Variations
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4
Q

Purpose of the Vitreous

  1. Pushes the retina up against what?
  2. Provides some metabolites for what 2 things?
  3. Big thing?
  4. Transmits light without what?
A
  1. the Choroid
  2. for Retina and the Lens
  3. Shock Absorber
  4. w/o Light Scatter due to Low Level of Metabolites
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5
Q

Asteroid Hyalosis

  1. What is it?
  2. Common over what age?
  3. Symptomatic?
  4. Uni/Bi?
  5. Associated with what Systemic Disease?
  6. dOES NOT AFFECT what 2 things?
  7. Tx?
    a. Exception?
A
  1. Multiple, Yellow-White Calcium-Phosphate Particles
  2. over 60 (1/200)
  3. Usually Asymptomatic: Doesn’t Cause Floaters or Interfere w/Vision
  4. UNI (75%)
  5. Diabetes Mellitus (30%)
  6. FA, or OCT
  7. None
    a. PPV if it becomes so severe that they affect VA or need to treat/manage retinal condition
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6
Q

Amyloidosis

  1. It’s a variety of conditions where what happens to normal Soluble Proteins?
  2. Can be associated with what?
  3. What part of the eye can be involved?
A
  1. they become insoluble (amyloids) and are deposited in various organs or tissues, disrupting normal function
  2. Multiple Myeloma
  3. ANY PART, but VITREOUS is MOST COMMON
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7
Q

Amyloidosis (2)

  1. Type of Opacities
  2. Diagnosis?
  3. Tx?
  4. What else?
  5. Prognosis?
A
  1. Glass-wool
  2. Biopsy; but lab tests can help (CBC, Liver Function)
  3. None needed unless vision affected
  4. PPV, but can recur
  5. Depends on Systemic Involvement
    * No. 1 cause of people who die over 110!
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8
Q

Persistent Hyperplastic Primary Vitreous

  1. Common?
    a. What is it?
  2. VA?
  3. Pupil looks white: What is it?
  4. What is seen behind the lens?
  5. What is emanating from ONH?
  6. What could be helpful to visualize this?
  7. Tx?
  8. Refer all what?
  9. Visual Prognosis depends on what?
  10. What improves Prognosis?
A
  1. RARE developmental Anomaly
    a. Abnormal regression of Hyaloid Artery and Primary Vitreous
  2. Decreased VA/Strab
  3. Leukocoria
  4. Pink/White Vitreal Membrane w/radiating vessels & Elongated ciliary processes
  5. Fibrovascular Stalk
  6. a B-Scan
  7. Retina Surgery and PPV w/in first few months of life
  8. ALL WHITE PUPILS
  9. on level of Maldevelopment
  10. Earlier Treatment
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9
Q

Posterior Vitreous Detachment (PVD)

  1. How common is it?
  2. Can occur Secondary to what?
  3. Symptoms?
    a. What diminishes over a week or two?
    b. Floaters?
  4. Eventually: Most patients do what?
  5. Vitreous doesn’t attach at what?
    a. Why?
  6. Vitreous DOES DETACH from what?
  7. Signs?
  8. MAY HAVE WHAT?
  9. MAY Have what else?
A
  1. MOST COMMON Vitreous Condition (50% by 50 y.o. and 65% by 65 y.o.)
  2. to TRAUMA, Surgery, Laser, RP, Myopia, DM
  3. Acute onset of Floaters and Flashes of Light: (Photopsias; esp. w/eye movement)
    a. Photopsia
    b. Stay and are bothersome
  4. learn to live with it.
  5. at the vitreous base cuz tightly adhered to retina here
  6. from ONH
  7. WEISS RING: circular vitreous floater of Glial tissue located anterior to ONH; Marks posterior face of Vitreous
  8. Vitreous Pigment Cells (usually not)
  9. Focal intra-retinal, pre-retinal or vitreous hemorrhage
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10
Q

PVD: MOA

  1. Vitreous strongly adhered to what?
  2. Gel of eye is maintained by what?
  3. Age breaks down what?
A
  1. to VITREOUS BASE (doesn’t detach in PVD)
  2. by Hyaluronic Acid (soluble)
  3. Hyaluronic acid bonds w/collagen and Water begins to escape the hold of the matrix
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11
Q

PVD: Mechanism

  1. Are individual collagen fibrils visible?
  2. As collagen fibrils group together, they become visible as what?
  3. Syneresis: What is it?
  4. PVD can be what 2 things?
  5. Flashes mean what?
  6. Fluid SHIFTS and ESCAPES. What happen?
A
  1. NO
  2. Vitreous Strands
  3. Liquefaction of vitreous gel causes dehiscence of Posterior hyaloid from retina and collapse of the vitreous base away from the macula and the Optic Disc
  4. Localized/Partial or TOTAL
  5. TRACTION
  6. Posterior Wall pulls away from retina. (Classic Weiss ring from ONH) (seen from shadow on the retina…can also see it in OCT)
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12
Q

Intermediate Uveitis/Pars Planitis

  1. What is it?
    a. Limited to what?
  2. Red eye/photophobia?
  3. Seen in whom?
  4. Uni/BI?
  5. Associated with what 2 things?
  6. % of all Uveitis?
  7. VA?
  8. Fibrovascular exudates Esp. INFERIORLY at PARS PLANA (called what)?
  9. % that see Vitreous Cells?
    a. What do they do?
  10. Anterior Cells/Flare?
  11. List of Differentials include many what?
A
  1. Inflammation
    a. to Vitreous Cavity involving Pars Plana and/or Ciliary Body of Unknown etiology
  2. No
  3. Children AND Young Adults
  4. BILATERAL USUALLY
  5. MS and Sarcoid
  6. 5-8% (rare in asians/AAs)
  7. Decreased VA
  8. SNOW BANKING!
  9. 100%
    a. They AGGREGATE (Snowballs)
  10. MINIMAL
  11. Many Posterior Uveitis Causes
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13
Q

Intermediate Uveitis/Pars Planitis

  1. 85% get what?
  2. Treat with what?
  3. 50% achieve a VA of what?
    a. % that resolve fully?
    b. 50% will have what?
  4. CME determines what?
  5. Important to treat Inflammation How?
A
  1. CME
  2. Sub-tenon’s Injectable Steroid! and Oral Steroids!
  3. 20/30 VA
    a. 15%
    b. Smoldering Chronic Disease
  4. VA outcome
  5. AGGRESSIVELY
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14
Q

Vitritis

  1. Inflammation of the Vitreous characterized by what?
    a. It’s a form of what? Associated with what?
  2. Graded on what?
    a. 1
    b. 2
    c. 3
    d. 4
A
  1. WBC’s in Vitreous
    a. of UVEITIS: Often associated w/Anterior Uveitis, but more often Intermediate or Posterior Uveitis
  2. Limited view of Retina
    a. Few Cells; Mild Obscuration
    b. Nerve and Retina Visible
    c. Only nerve and Large vessels visible
    d. Nerve and Vessels not visible
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15
Q

Causes of Posterior Uveitis that may have VITRITIS

  1. 9
A
  1. ARN and PORN; CMV, VKH, MEWDS

Candidiasis; Syphilitic Chorioretinitis; Toxocariasis; Toxoplasmosis

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16
Q

Vitreous Hemorrhage

  1. What is it?
    a. May notice what when looking at light?
    b. Poor view of what?
    c. Old Hemes may look what color?
    d. Settle how?
A
  1. Sudden Onset of Floaters and Decreased VA
    a. Reddish Tinge to vision
    b. Poor view of Fundus
    c. Gray-White
    d. Settle Inferiorly
17
Q

Causes of Vitreous Hemorrhage

  1. 8
A
  1. Diabetic Retinopathy
  2. Hypertensive Retinopathy
  3. Valsalva Retinopathy
  4. Retinal break
  5. PVD
  6. Juvenile Retinoschesis
  7. Ruptured RAM
  8. Terson’s Syndrome
18
Q

Vitreous Hemorrhage

  1. Thorough Eval of what?
    a. This includes what technique?
  2. If you have poor views, what scan should you use?
  3. Tx?
  4. What should they do when they sleep?
  5. PPV when?
A
  1. Retinal Evaluation
    a. Scleral Depression
  2. B-Scan
  3. Conservative Tx, unless hole or tear
  4. Elevate their head
  5. If persistent for idiopathic after 6 months or for Non-clearing Heme if DM after one month
19
Q

Most important things to look for in the Vitreous

  1. Examine using what?
    a. Light Level?
    b. Compare what?
    c. Know what’s NORMAL!!!
    d. Look for what three things?
A
  1. SLE: Push thru lens using parallelpiped and Optic Section
    a. TURN LIGHT LEVEL ALL THE WAY UP
    b. Left/Right eye

d. Shafer’s Sign (tobacco dust); Snowballs, Blood (also…looking to see if vitreous is clear…i.e…looking for this stuff)
* Blood = Neo and Vitreous Contraction!

20
Q

PPV

  1. What is it?
  2. How is procedure done?
  3. What devices pass thru these incisions?
A
  1. Trans Pars Plana Vitrectomy (TPPV) used to treat many retinal Disorders
  2. Thru 3 tiny incisions in the Eye for 3 separate instruments. Incisions Placed in PARS PLANA of the EYE (located b/w Iris and Retina).
    * Entering eye thru this location avoids DAMAGE to the retina and crystalline lens
  3. Light Pipe (high-intensity flashlight illuminates inside of the eye), Infusion Port (Replaces fluid in the eye and maintains proper pressure w/in the eye), and Vitreous Cutting Device (tiny guillotine) (done in OR under local or general anesthesia)

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