Keys

Question 1

What are the clinical features of Von Hippel Lindau Syndrome?

Answer 1

(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

Question 2

What are the features and likely sources for different retinal emboli?

Answer 2

(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

Question 3

List causes of cotton wool spots.

Answer 3

GCA; DM; HT; CRAO; CRVO; Radiation; HIV; HepC; SLE; Wegerner’s; PAN; Lyme; Toxo; Mucormycosis

Question 4

List causes of Roth Spots.

Answer 4

Leukaemia; Septic chorioretinitis; DM; Pernicious anaemia; SLE; scurvy; sickle cell

Question 5

List causes of NVI.

Answer 5

DM; CRVO; CRAO; OIS; Chronic RRD; Chronic Uveitis; Radiation; Tumour (Rb); Trauma (surgery);

Question 6

List causes for nyctolopia.

Answer 6

Refractive error (myopia); glaucoma; small pupil; RP; CSNB; phenothiazines; Vit A deficiency; choroideremia

Question 7

What are the clinical features of Refsum Disease and how is it treated?

Answer 7

FEATURES: RP; ichtyosis; anosmia; deafness; neuropathy/ataxia; mental retardation; cerebellar ataxia
TREATMENT: Restricting phytanic acid (found in animal fats/milk)

Question 8

Outline the clinical findings for hypertensive eye disease.

Answer 8

(1) Retinopathy
(2) Choroidopathy (Elschnig spots, Siegrist streak, exudative RD)
(3) Papillopathy (Disc swelling)
(4) Ancillary (Macroaneurysm, AION, motor palsies, RVO)

Question 9

Compare Choroidaemia to Gyrate Atrophy.

Answer 9

(1) Choroideremia - XLR – CHM gene; degeneration of choroid, RPE and photoreceptors
(2) Gyrate Atrophy - AR – ornithine aminotransferase deficiency; (↑ ornithine levels) scalloped atrophic areas

Question 10

List causes for Choroidal folds.

Answer 10

Idiopathic, hypermetropia, retrobulbar mass, choroidal mass, posterior scleritis, uveitis, IOIS, TED, Hypotony, papilloedema, meds: Diamox, topiramate.

Question 11

What are the causes for toxic retinopathy?

Answer 11

(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)

Question 12

What are the causes of a crystalline retinopathy?

Answer 12

• Talc, Canthaxanthine, Tamoxifen; Oxalosis, Methoxyflurane; Bietti’s crystalline dystrophy, calcified drusen, AD crystalline dystrophy

Question 13

What are the causes of a bull’s eye maculopathy?

Answer 13

COMMON: Chloroquine, Clofazimine, Stargardt’s, Cone-Rod Dystrophy,
LESS COMMON: Benign Concentric Annular dystrophy; LCA; Bardet-Biedl; AD cerebroataxia; lipofuscinosis (Battens)

Question 14

What are the tests for thrombophilia?

Answer 14

APTT; Fibrinogen; Factor V; Protein C & S; Antithrombin III; Anticardiolipin; Lupus Anticoagulant; Homocysteine; plasminogen

Question 15

What are the intravitreal doses of Avastin, Lucentis and IVTA?

Answer 15

Avastin - 1.25 mg in 0.15ml
Lucentis - 0.3mg in 0.3ml
IVTA - 4mg in 0.1ml

Question 16

Outline your screening regimens for DR?

Answer 16

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

Question 17

When would you consider PRP for severe NPDR?

Answer 17

(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

Question 18

What are the Laser settings for PRP?

Answer 18

(!) 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

Question 19

What are the laser settings for treating Diabetic Macular Oedema?

Answer 19

(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

Question 20

How do you increase the burn intensity?

Answer 20

• ↑ power
• ↑ duration (least likely of the three factors to rupture Bruchs’, but most painful)
• ↓ spot size (concentrates laser dose)

Question 21

List some indications for PDT?

Answer 21

1. Choroidal haemangioma; 2. Polypoidal Disease; 3. Amelanotic melanoma; 4. Multifocal CSR; 5. Inflammatory CNV