Keys Flashcards
What are the clinical features of Von Hippel Lindau Syndrome?
(1) Retinal capillary haemangiomas (multiple, bilateral) – proliferating endothelial cells forming primitive capillary networks
(2) CNS haemangioblastoma
(3) Phaeochromocytoma
(4) Renal cell carcinoma
(5) Cysts of kidneys, liver, pancreas, epididymis, ovaries, lungs
What are the features and likely sources for different retinal emboli?
(1) Cholesterol (Hollenhorst): carotid artery ICA/CCA, located in branching points, golden/refractile
(2) Platelet-fibrin: large vessel atherosclerosis, multiple, dull grey
(3) Calcific: diseased cardiac valves, single, close to disc, chalky white
List causes of cotton wool spots.
GCA; DM; HT; CRAO; CRVO; Radiation; HIV; HepC; SLE; Wegerner’s; PAN; Lyme; Toxo; Mucormycosis
List causes of Roth Spots.
Leukaemia; Septic chorioretinitis; DM; Pernicious anaemia; SLE; scurvy; sickle cell
List causes of NVI.
DM; CRVO; CRAO; OIS; Chronic RRD; Chronic Uveitis; Radiation; Tumour (Rb); Trauma (surgery);
List causes for nyctolopia.
Refractive error (myopia); glaucoma; small pupil; RP; CSNB; phenothiazines; Vit A deficiency; choroideremia
What are the clinical features of Refsum Disease and how is it treated?
FEATURES: RP; ichtyosis; anosmia; deafness; neuropathy/ataxia; mental retardation; cerebellar ataxia
TREATMENT: Restricting phytanic acid (found in animal fats/milk)
Outline the clinical findings for hypertensive eye disease.
(1) Retinopathy
(2) Choroidopathy (Elschnig spots, Siegrist streak, exudative RD)
(3) Papillopathy (Disc swelling)
(4) Ancillary (Macroaneurysm, AION, motor palsies, RVO)
Compare Choroidaemia to Gyrate Atrophy.
(1) Choroideremia - XLR – CHM gene; degeneration of choroid, RPE and photoreceptors
(2) Gyrate Atrophy - AR – ornithine aminotransferase deficiency; (↑ ornithine levels) scalloped atrophic areas
List causes for Choroidal folds.
Idiopathic, hypermetropia, retrobulbar mass, choroidal mass, posterior scleritis, uveitis, IOIS, TED, Hypotony, papilloedema, meds: Diamox, topiramate.
What are the causes for toxic retinopathy?
(1) Chloroquine >3.5mg/kg/D, Hydroxychloro >6.5mg/kg/D. Screen pre-Rx, yrly vs 5yrs (near VA; red on black Amsler; 10-2; mfERG)
(2) Vigabatrin- binasal defects, normal retina. Baseline, then r/v 6/12 1st 3 years, then yearly
(3) Thioridazine (>1g/day toxic, usual 2g/day toxic usual retina
(6) Tamoxifen (toxic>180mg/day for 1 year, usual<40mg/day)→crystalline maculopathy, vortex, CMO, optic neuritis.
Other crystalline (canthaxanthine, methoxyflurane→oxalosis, nitrofurantoin)
What are the causes of a crystalline retinopathy?
- Talc, Canthaxanthine, Tamoxifen; Oxalosis, Methoxyflurane; Bietti’s crystalline dystrophy, calcified drusen, AD crystalline dystrophy
What are the causes of a bull’s eye maculopathy?
COMMON: Chloroquine, Clofazimine, Stargardt’s, Cone-Rod Dystrophy,
LESS COMMON: Benign Concentric Annular dystrophy; LCA; Bardet-Biedl; AD cerebroataxia; lipofuscinosis (Battens)
What are the tests for thrombophilia?
APTT; Fibrinogen; Factor V; Protein C & S; Antithrombin III; Anticardiolipin; Lupus Anticoagulant; Homocysteine; plasminogen
What are the intravitreal doses of Avastin, Lucentis and IVTA?
Avastin - 1.25 mg in 0.15ml
Lucentis - 0.3mg in 0.3ml
IVTA - 4mg in 0.1ml
Outline your screening regimens for DR?
None: At least 2 yearly Minimal NPDR: At least yearly Moderate NPDR: At least 6 monthly Severe NPDR: At least 2-4 monthly PDR: Prompt PRP
When would you consider PRP for severe NPDR?
(1) Poor follow-up compliance (particularly if T2DM)
(2) Severe disease in the other eye
(3) Impending cataract surgery
(4) Evidence of retinopathy progression
(5) Renal disease
(6) Pregnancy
What are the Laser settings for PRP?
(!) 500 μm retinal spot size
(2) 0.2s
(3) Power: start 200mW with moderate burn (4) Green laser
(5) 1200-1600 burns; half burn width apart; from posterior pole to equator, 2DD from fovea to equator
(6) Over 3 session spacing 1-2/52 in between
(7) Review 2-4/12 post
(8) Gonio for NVA/NVI
What are the laser settings for treating Diabetic Macular Oedema?
(1) 50-100 μm
(2) Focal/grid macular laser to areas of focal leak(thickening) & capillary non-perfusion.
(3) 0.1 s or less
(4) Power: start 50 mW and go up: whitening/ darkening of MA, light burn for grid/barely visible; green (red an option)
(5) Lens: A. centralis or Goldmann
(6) Avoid confluent Rx 700 μm from centre - more conservative now
(7) Review within 3/12 retreat in 4/12
STUDIES:
• ETDRS Macular Laser: 500 μm from centre, 300 μm if VA worse than 6/12, FAZ intact,
• ETDRS Focal treatment: Direct treatment of all leaking MA between 500-3000μm from the centre
• ETDRS Grid pattern: Treat areas of diffuse leakage and/or capillary drop-out more than 500 μm from centre
How do you increase the burn intensity?
- ↑ power
- ↑ duration (least likely of the three factors to rupture Bruchs’, but most painful)
- ↓ spot size (concentrates laser dose)
List some indications for PDT?
- Choroidal haemangioma; 2. Polypoidal Disease; 3. Amelanotic melanoma; 4. Multifocal CSR; 5. Inflammatory CNV
