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Gaby Ophtho Questions Review > Inflammatory chorioretinopathies > Flashcards

Inflammatory chorioretinopathies Flashcards

1
Q

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A
  • Birdshot: Age 30-70 (older); F>M, Bilateral, 80-98% are HLA A29 positive. Insiduous onset, chronic, recurrent. Prognosis guarded without treatment. Therapy: systemic/local steroids; IMT.
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2
Q

Birdshot Symptoms

A
  • Blurred vision, floaters, photopsias, disturbed color / night vision.
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3
Q

Birdshot Exam

A
  • vitritis, ovoid creamy white-yellow post-equatorial lesions
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4
Q

Birdshot Complications

A

vasculitis, disc edema, CME, CNV (6%)

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5
Q

Birdshot FA

A

early hypofluorescence, late stain, leakage from disk, CNVM

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6
Q

Birdshot ICG

A

hypofluorescent lesions more numerous than on exam

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7
Q

Birdshot FAF

A

hypoautofluourescent lesions more numerous than clinically apparent; placoid macular hypoautofluoresence with central vision loss

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8
Q

Birdshot OCT

A

ME, loss of IS/OS, suprachoroidal fluid

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9
Q

Birdshot ERG

A

abnormal rod/cone response

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10
Q

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A
  • APMPPE: Age 20-50 (young). M=F. Bilateral. Viral prodrome, cerebrovasculitis, CSF abnormalities. Course is acute and self-limited. Visual prognosis is good. Therapy is observation; steroids if CNS involvement.
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11
Q

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  • Serpiginous Chorioretinitis: Age 20-60 (young-middle). M=F. Bilateral but asymmetric. Systemic association HLA B7. Rule out TB. Onset/course is variable and self-limited. Visual prognosis is guarded. Therapy is systemic/ local steroids and IMT. Anti-VEGF w/wo laser for CNVM.
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12
Q

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A
  • Age 9-69 (usually more young). F>M (3:1). Bilateral. Onset/course is insidious, . chronic/recurrent. Visual prognosis: guarded. Treatment: steroids, IMT. Anti-VEGF, +/- laser for CNVM.
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13
Q

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PIC: age 18-40 (young). F (90%); bilateral. Onset/course is acute/self-limited. Prognosis is good if no CNVM. Treatment is systemic/local steroids, IMT, antivegf +/- laser

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14
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SFU: subretinal fibrosis and uveitis syndrome. Age 14-34 (Young). F>M (>95%). Asymmetric. Insidious, chronic, recurrent. Prognosis is guarded. Treatment is steroids for CME if present

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15
Q

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A
  • MEWDS: young (10-47); F (3:1), unilateral. Assc’n with viral prodrome in 50%. Course is acute, self limited. Prognosis is excellent. No treatment, just observation.
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16
Q

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A
  • ARPE: young (16-40). M=F. Unilateral (75%). No associated systemic issues. Acute self-limited. Prognosis is excellent. No treatment.
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17
Q

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AZOOR: young. (13-63). F (3:1). Unilateral 24% of the time, bilateral 76% of the time. Associated with systemic autoimmune disease 28% of the time. Insiduous, chronic, recurrent (31% of the time). Prognosis is guarded. Treatment is steroids, IMT +/- antivirals

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18
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A
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19
Q

APMPPE symptoms

A

blurred vision, scotomata, photopsias

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20
Q

APMPPE exam

A

multifocal flat gray-white lesions 1-2 DD, RPE with evolving pigment

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21
Q

APMPPE complications

A

disc edema, pigmentary changes

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22
Q

APMPPE FA

A

acute lesions, early blockage, late staining, late window defects

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23
Q

APMPPE ICG:

A

hypofluorescent spots

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24
Q

APMPPE FAF

A
  • hyperfluourscent areas corresponding to FA blockage and hypofluorescent areas corresponding to staining.
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25
Q

APMPPE OCT

A

outer retinal hyper-reflectivity with intra retinal and subretinal fluid

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26
Q

Serpiginous symptoms

A

blurred vision, scotomata

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27
Q

Serpiginous exam

A
  • geographic yellow-gray macular chorioretinal lesions with centrifugal extension. Activity is at leading edge with atrophy in its wake.
28
Q

Serpiginous complications

A

CNVM (25%), RPE mottling, scarring, loss of choriocapillaris

29
Q

Serpiginous FA:

A

early hypofluorescence, late staining/ leak of active border/ CNVM

30
Q

Serpiginous ICG

A

early hypofluorescence, late stain, more widespread than on exam

31
Q

Serpiginous FAF

A

hyperfluorescent active lesions, hypofluorescent regressed lesions

32
Q

Serpiginous OCT

A
  • outer retinal hyperreflectivity in active lesions, RPE atrophy in regressed lesions
33
Q

MCP symptoms

A

blurred vision, floaters, photopsias, metamorphopsias

34
Q

MCP exam

A
  • myopia, anterior uveítis (50%), vitritis (100%), active white-yellow lesions evolving to punched out scars.
35
Q

MCP complications

A
  • disc edema, peripapillary pigment changes, CME (14-44%), CNVM (33%).
36
Q

MCP FA:

A

early block, late stain/leakage

37
Q

MCP ICG

A
  • many hypofluorescent lesions, confluence more around the nerve, more than on exam
38
Q

MCP OCT:

A

sub-RPE deposits with overlying retinal distruption

39
Q

MCP ERG

A

abnormal, extinguished responses

40
Q

PIC symptoms:

A

paracentral; scotoma, photopsias, metamorphopsias

41
Q

PIC Exam

A

myopia; vitritis is ABSENT; white-yellow chorioretinal lesions

42
Q

PIC Complications

A

CNVM (17-40%), serous detachment over confluent lesions

43
Q

PIC FA:

A

early block or HYPERfluorescence, variable late stain/leakage of acute lesions

44
Q

PIC ICG:

A

hypofluorescent peripapillary/posterior pole lesions.

45
Q

PIC FAF/OCT

A

similar to MCP. sub-RPE deposits with overlying retinal distruption

46
Q

SFU symptoms

A
  • blurred vision, decreased vision
47
Q

SFU Exam:

A

moderate vitritis, yellow-white lesions in posterior pole to mid-periphery. RPE hypertrophy, atrophy, large stellate zones of subretinal fibrosis.

48
Q

SFU complications

A
  • retinal detachments, CME, CNVM
49
Q

SFU FA

A
  • alternating hyper/hypo fluorescent areas.
50
Q

SFU OCT

A

variable edema, SR fluid, subretinal fibrosis

51
Q

MEWDS symptoms

A

blurred/decreased vision, scotoma, photopsias

52
Q

MEWDS exam

A

myopia, mild anterior uveitis, vitritis, small white-orange evanescent perifoveal dots.outer retina/RPE macular granularity.

53
Q

MEWDS complications:

A

disc edema, venous sheathing

54
Q

MEWDS FA

A
  • early punctate hyperfluorescence, wreathlike configuration. Late staining of lesions/ optic nerve.
55
Q

MEWDS ICG

A
  • multiple hypofluorescent spots, more numerous than on exam.
56
Q

MEWDS FAF:

A
  • hyperfluorescent spots.
57
Q

MEWDS OCT:

A

abnormal IS/OS

58
Q

ARPE exam

A

small hyperpigmented lesions with yellow halos, unassociated vitritis

59
Q

ARPE FAF

A

early hyperfluorescence with surrounding halo of hypofluorescence.

60
Q

Azoor symptoms

A

photopsias, scotoma

61
Q

Azoor exam:

A
  • initially subtle RPE changes, late pigment migration, focal perifoveal sheathing.
62
Q

Azoor complications

A

RPE mottling, occasional CME

63
Q

Azoor OCT

A

loss of IS/OS.

64
Q
  • Inflammatory chorioretinopathies helpful hints (5):
A
  • (1) all bilateral except SFU/serpiginous (asymmetric), MEWDS, (unilateral), ARPE (unilateral 75%), Azoor (unilateral 24% of the time, bilateral 76% of the time).
  • (2) all can be seen younger except birdshot tends to be older
  • (3) F>M except: APMPPE, serpiginous, ARPE (M=F). PIC is 90% F. SFU is >95% F.
  • (4) PIC = NO vitritis. MCP = always vitritis
  • (5) Associated CNVM: serpiginous (25%), MCP (33%), PIC (17-40%), SFU, Birdshot (6%)
65
Q
A

Gaby Ophtho Questions Review (11 decks)

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