Ophthaa RD Flashcards
Ocular anatomy ant. to pos.
Cornea > aqueous humor > Iris > Lens/ciliary body > Vitreous humor > Retina/ON > choroid > Sclera
Limbus > Pars plica(2m) > Pars plana (4mm) > Ora serrata
Layers of the retina Ant. to Pos.
ILM
NFL
GCL
IPL
INL
OPL
ONL
ELM
PR
RPE
Bruchs membrane
Choroid
Vitreous humor content and adhesion points:
99% water, 1% hyaluronic acid, collagen, hyalocytes
Optic disc, Fovea, BVs, Lattice degenerations
Vitreous base (overlays ora.)
RRD risk factors:
^age, myopic (>6D)
Ocular surgery (20x Cat.)
Trauma (retinal break / Vit. liquifaction)
RD in fellow eye (10%)
Retinal degenerations: lattice, white w/wo pressure (retina thinning)
FOH (myopia)
Systemic: Marfan’s (Tall), Ehler-Danlos, Sticklers (collagen disorder > scleral elongation)
Pathogenesis of RRD:
Vitreous degeneration > liquefaction > acute PVD w/ collapse > traction > tear > fluid influx via break > layer separation > dome shaped elevation
* Vit. liquifaction + retinal break > RRD
RRD symptoms:
Flashes 60% (Vit. pulls on PR’s)
Floaters (Weiss ring, cobweb, shower of red spots)
Painless vision loss
VF defect (curtaining)
RRD signs:
VA loss
RAPD (Extensive RD)
IOP decrease (ciliary shock > low aqueous production or aqueous misdirection)
Iritis
Shafer’s sign (RPE pigment in AC)
Retinal break (50% will have several breaks)
Lattice degeneration
Vit. haem
TRD causes:
- Any condition causing Vit. Haem or ischemia to pos. retina
DR > PDR
CRAO/CRVO
retinopathy of prematurity
retinal vasculitis
sickle cell anaemia
penetrating trauma
RRD visualization:
Convex, opaque, corrugated, loss of choroid pattern, dark/blurred BV’s
Pathogenesis of TRD:
Pos. retina ischemia > Hypoxia > VEGF release > leaky BV’s > Vit. Haem > clotting/scar tissue > contraction
* Scar tissue formation > NSR pulled from RPE
* U/ partial PVD
TRD symptoms:
Gradual painless vision loss
Hx eye condition (DR/BV occlusion)
No flashes (gradual/incomplete PVD)
Floaters (If vit. haem)
Exudative RD causes:
Infection (TB, syphilis, Lyme)
Inflammation (Uveitis, scleritis)
Choroidal tumors (melanoma, hemangioma)
CSR
Hydrostatic (malignant hypertension)
Vascular (microaneurysm)
Sx (PRP)
TRD signs:
Fibrovascular membrane
RD
Features of underlying cause (retinal haem. / CWS / Exudates)
Pathogenesis of exudative RD:
RPE pump failiure > retinal/choroidal BV fluid influx > Accumulation of subretinal fluid > NSR seperation from RPE
Exudative RD symptoms:
Blurry vision
No flashes/pain
R/ floaters (if vitritis)
Assoc. symptoms of panuveitis (pain, redness, photophobia)
Signs of exudative RD:
Mobile retinal detachment
RD convex, smooth, no corrugation
Assoc. findings (retinitis, choroiditis, tumor)
TRD visualisation
Concave, taut, shallow
U/ no retinal breaks
Signs of long standing RD:
Retinal thinning
Fixed retinal folds
Secondary intraretinal cysts
Subretinal demarcation lines
Proliferative vitreoretinopathy
RD vs retinoschisis:
RD: convex/corrugated, unilateral, relative scotoma, demarcation line, breaks, cells in vitreous
Retinoschisis: Convex/smooth, U/bilateral, absolute scotoma, no demarkation, no breaks, clear vitreous
RD referral details:
Px details
VA, latest RA/BCVA
IOP
Status of lens
Presence of tears
Locations and extent of RD
Macula status
Sx for RRD:
Pars plana Vitrectomy (common)
Scleral buckle (anterior break w/clear media)
Pneumatic retinopexy (small/superior break)
Indications for RD Sx:
recent onset
Superior RD
Macula off < 3 days (or mac on)
Pneumatic retinopexy procedure:
Perfluropropane injection > supine position > laser around break
only for small breaks in superior 8’ clock hour of retina
Scleral buckle:
explant sutured on sclera > RPE connected to NSR
Requires clear media
can induce refractive error, strabismis, ^IOP, anterior segment ischemia
Pars plana vitrectomy complications:
Cataract
Hypotony
Vit. Haem
Endopthalmitis
Glaucoma
Latogenic breaks
