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Ophthalmology > Medical retina > Flashcards

Medical retina Flashcards

1
Q

Name some retinovascular changes in diabetes

A

loss of endothelial tight junctions
capillary basement membrane thickening
pericyte loss
microaneurysms form
acellular capillaries

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2
Q

Diabetic retinopathy risk factors

A

duration of diabetes
glucose control
BP control

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3
Q

How is diabetic retinopathy classified?

A

Non-proliferative diabetic retinopathy

Diabetic maculopathy (non-proliferative diabetic retinopathy in the macula)

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4
Q

How can non-proliferative diabetic retinopathy be classified?

A

mild
moderate (microaneurysms, dot-blot haem, cotton wool spots, exudates)
severe (pre-proliferative) with signs of retinal ischaemia (dilated veins, large blot haems, venous bleeding, intraretinal microvascular abnormalities, cotton wool spots)

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5
Q

What are patients with severe non-proliferative diabetic retinopathy at risk of?

A

retinal new vessel growth (proliferation)

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6
Q

How can non-proliferative diabetic retinopathy be identified on the retina?

A

microaneurysms (1st clinical sign)
exudate (intraretinal lipid deposits)
dot haemorrhages (cannot distinguish from microaneurysms)
blot haemorrhages
cotton wool spots (axoplasmic debris from nerve-fibre layer infarcts)

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7
Q

What can retinal argon laser be used to treat?

A

used to treat macular oedema ‘threatening’ the fovea and leading to loss of acuity

macular laser reduces moderate vision loss from diabetic macular oedema

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8
Q

What light illuminates fluorescein?

A

blue light

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9
Q

What are the 2 subtypes of proliferative diabetic retinopathy?

A

new vessels disk (NVD) - retinal new vessels from optic disc

new vessels elsewhere (NVE) - retinal new vessels away from the optic disc

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10
Q

Which way do vessels grow in proliferative diabetic retinopathy?

A

forwards into the vitreous

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11
Q

What are the 2 subtypes of retinal vein occlusion?

A

branch retinal vein occlusion (BRVO) - occlusion of a branch of the retinal vein as it is crossed by a retinal arteriole

central retinal vein occlusion (CRVO) - occlusion of the vein in optic nerve as it runs alongside the central retinal artery

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12
Q

Symptoms of severe/ischaemic central retinal vein occlusion

A

acute onset - often in the night and noticed on waking
painless loss of vision
visual acuity reduced to between 6/60 and hand motions vision

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13
Q

Retinal signs of severe/ischaemic central retinal vein occlusion

A

severe intraretinal haemorrhages throughout the retina
engorged retinal veins
disc swelling
macular oedema
cotton wool spots
RAPD present - indicating severe loss of afferent visual input

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14
Q

Severe/ischaemic central retinal vein occlusion risk factors

A

ageing
hypertension
arteriosclerosis
hyperlipidaemia
prothrombotic conditions

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15
Q

Mild/non-ischaemic central retinal vein occlusion symptoms

A

acute onset - often at night and noticed on waking
painless loss of vision
visual acuity reduced to between 6/12 and 6/36

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16
Q

Retinal signs of mild/non-ischaemic central retinal vein occlusion

A

mild to moderate intraretinal haemorrhages throughout the retina
engorged retinal veins
disc swelling
macular oedema
no RAPD - indicates maintained afferent visual input

17
Q

How is central retinal vein obstruction treated?

A

repeated intravitreal anti-VEGF antibody injections

this can resolve macular oedema, improving visual acuity

18
Q

Name 2 anti-VEGF drugs

A

Lucentis (ranibizumab)
Eylea (aflibercept)

19
Q

What is rubeotic glaucoma?

A

peripheral retinal ischaemia leads to growth factor production (VEGF)
VEGF diffuses through the eye and stimulates growth of new blood vessels (rubeosis) on the iris and in the drainage angle - this can narrow the angle and cause glaucoma

20
Q

Symptoms of branch retinal vein occlusion

A

acute onset - often occurs in night and noticed on waking
painless loss of vision
visual acuity reduced to between 6/9 and hand motions vision - may be asymptomatic if fovea not affected

21
Q

Retinal signs of branch retinal vein occlusion

A

intraretinal haemorrhages in area of affected vein branch only
engorged branch retinal vein
macular oedema
cotton wool spots
no RAPD - smaller area of retina involved than CRVO

22
Q

Retinal signs of hypertensive retinopathy

A

thickened arteriole wall - increased central light reflex (silver wiring)

narrowed/straightened arterioles

AV crossing changes - arteriovenous nipping

BRVO occurs at AV crossings

23
Q

What is the leading cause of blindness in the western world?

A

age-related macular oedema

24
Q

Age-related macular degeneration risk factors

A

age
family history
smoking

25
Q

Pathogenesis of age-related macular degeneration

A

complement system regulates innate immunity to infection/stress, initiating inflammation and response to pathogens
complement system dysregulation can lead to chronic inflammation

when complement system becomes chronically active in the eye, it can mediate damage to the choroid, RPE and photoreceptors, causing localised inflammation and cell death

26
Q

How can the retina and other structures be visualised to see their thickness and any oedema?

A

optical coherence tomogram (OCT)

27
Q

What does early age-related macular degeneration look like on the retina?

A

drusen deposits of shed photoreceptor material

retinal pigment epithelium atrophy

28
Q

What does late age-related macular degeneration cause?

A

progressive central vision loss

29
Q

What are the 2 types of late age-related macular degeneration?

A

wet AMD = vascular
dry AMD = atrophic

30
Q

Describe late wet AMD

A

choroidal new vessels grow under the retinal pigment epithelium (RPE) or retina and leak plasma causing sub-retinal fluid and retinal oedema

haemorrhage, fibrosis and exudate can occur

process driven by VEGF

31
Q

How is wet AMD treated?

A

anti-VEGF monoclonal antibody intravitreal injections

32
Q

What does end-stage we AMD disease look like on the retina?

A

pigment clumping
sub-retinal fibrosis

33
Q

Describe what causes late dry AMD

A

thickening of retinal pigment epithelium basement membrane (Bruch’s membrane) and sclerosis of choroidal vessels
associated with progressive atrophy
leads to patches of loss of choroid/RPE/retina in an irregular shape (geographic atrophy)
these patches enlarge, causing scotoma and visual acuity loss of fovea affected

34
Q

Is dry AMD treatable?

A

no
slowly progressive vision loss over months to years

35
Q

What does amaurosis fugax do to vision?

A

transient and sudden monocular blindness
curtain that obscures vision in one eye

36
Q

What can cause amaurosis fugax?

A

carotid atheroma - (fibrin-platelet or cholesterol emboli)
cardiac valves (calcific emboli)

37
Q

What causes central retinal artery occlusion?

A

carotid atheroma is main cause - cholesterol or fibrin-platelet emboli
cardiac calcified aortic and mitral valvular lesions

can be due to giant cell arteritis

38
Q

Examination signs of central retinal artery occlusion

A

retinal whitening due to infarcted swollen inner 2/3 retina supplied by central retinal artery

cherry-red spot due to no inner retina covering fovea centre

retinal infarction causes late optic atrophy (pale optic disc) and retinal artery narrowing

39
Q

What causes the visual symptoms of GCA?

A

ischaemic optic neuropathy

Ophthalmology (10 decks)

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