Optho Flashcards
risk factors for cataracts
DRATS-MUD Dm Rtx Atopy Trauma Steroids Myotonic dystrophy Uveitis Downs
MCC reversible blindness
cataracts
PC cataracts
painless gradual decrease VA glare halos around lights at night dimness decrease colour intensity- CLOUD/ BLURRY VISION monocular diplopia
3 types of cataracts
- cortical
- nuclear sclerosis
- posterior subcapsular
cortical cataracts associated with
DM and aging
nuclear sclerosis a/w
aging
NB extra facts for nuclear sclerosis
brunescent-yellowish
SECOND SIGHT PHENOMENA
posterior subcapsular=
FROSTED GLASs; posterior adjacent to the capsule
a/w DRATS-intraocular inflammation
diagnostic tests for cataracts
- VA
- Opthalmoscope- red reflex
- Slit lamp
name of surgery for cataracts
phacoemulsification: sutureless 3mm incision AND place intraocular lens
complications of cataracts surgery
RARE C-GERD Cystoid macular edema Glaucoma Endopthalmitis Retinal detachment Dislocated IOL
decrease aqueous production drugs
AB-D-P
Alpha agonists- AD, brimonidine
Betablockers- timolol
Diuretics
increase aqueous outflow drugs
Cholinomimetics- pilocarpine, carbachol
PG’s- latanoprost
BOTH: decrease aqueous production
increase aqueous outflow
ALPHA AGONISTS
definition of glaucoma
- optic nerve damage
- visual field defect
- +/- IOP
optic nerve head damage in glaucoma
loss of ganglion cells and axons, thus loss of neuroretinal rim–> ENLARGEMENT of optic disc= cupping
EXTRA: spectrum of optic nerve damage
- pallor and cupping of optic disc: small paracentral scotoma
- concentric enlargement: arcuate defect
- superior expandion: arcuate defect
- advanced total cupping: temporal central island
different types of glaucoma
- POAG
- Low tension glaucoma
- Ocular HTN
- Chronic closed angle glaucoma
- secondary glaucoma- rubeotic
rubeotic glaucoma
neovascularisation secondary to DM
low tension glaucoma
glaucomatous disc with normal IOP
who is at risk for low tension glaucoma
- women>60
- secondary vasc insuff
ocular HTN
normal disc with increase IOP
chronic closed angle glaucoma diagnosis based off of….
appearance of drainage angle
trabecular meshwork covered by lens
similar glaucomatous disc with increased IOP
risk factors for POAG
- increase IOP
- increase age
FEMD
family hx
ethnicity- afrocarribean
myopia
DM
diagnosis of glaucoma
- VA– advanced
- Pupil rxn- RAPD with asym optic n damage
- gonioscopy- angle- open or closed
- Goldmann tonometry– applanation
- fundosocpy– cupping
- Humphrey visual fields
monitoring disease progression in glaucoma
- Fundoscopy
- Humphrey vf
treatment of glaucoma
PG or Betablocker– individually then together, then CA inhibitor, then
Trabeculectomy
risk factors to becoming blind with glaucoma
severity at presentation
LE
rate of progression
dry ARMD
RPE atrophy– coalescence of depigmented RPE= clump of focal hypo/hyperpigmentation
bruch membrane
area separating inner choroidal vessels from RPE
drusen
white deposits/lipofuscin between RPE and photoreceptors
wet ARMD secondary to
- inflammation
- submacular haemorrhage
- macular edema/exudate
END STAGE ARMD
GEOgraphical atrophy
SCARRING
IRREVERSIBLE loss of central vision
risk factors for ARMD
- female
- increasing age
- smoker
- caucasian
- blue eyes
- family history
PC ARMD
- metamorphopsia
- central scotoma
- reading difficulties
2 types of wet
occult
classic
classic wet ARMD
well defined leakage
occult wet ARMD
mottled or ill-defined leakage
dx ARMD
- VA/VF
- Amsler grid
- OCT
- Fluorescin angio
dry ARMD tx
low vision magnifying aids
social services
wet ARMD
intravitreal VEG-F– 3 months, then maintenance
- 2/3= stabilize
- 1/3= improve
exogenous antioxidant vitamins
- vits C, E
- Beta-carotene
- Zn
macular pigments
- lutein
- zeaxathin
risk factors for DM retinopathy
- CV risk factors
- duration
- ethnicity– black
- anaemia
- puberty
- prego
microvascular pathophysiology for DM
capillary leakage–> ischaemia–> vascular occlusion
parasite loss
endothelial damage
neuroretinal pathophysiology for DM
impaired neurotransmission–> apoptosis
late PC of DM
DECREASE VA= LATE
- macular edema= mcc vision loss
- VH
- retinal tractional detachment
clinical findings for DM retinopathy
- VA
- anterior segment (3)
- dilated fundal exam (3)
anterior segment findings DM retinopathy
- IRIS NEOVASC
- glaucoma- rubeotic- increase IOP
- cataracts- lens
dilated fundal exam DM retinopathy
- DM retinopathy
- vascular occlusions
- AION
dx of DM retinopathy
EXACT SAME AS ARMD (still do amsler in case of metamophopsia)
tx of DM retinopathy
- systemic- cv rf’s
- screening- annual, vital
- laser tx
- surgery= vitrectomy
- intravitreal Veg-F
laser tx indicated for…
- maculopathy
2. proliferative
maculopathy benefit from laser tx
- closes leaky vessels
- stimulates RPE pump
- decreases edema
- stabilizes vision
proliferative benefit from laser tx
- destroys ischaemic retina
- decreases angiogenic GFs
focal/ grid laser tx….
MACULOPATHY
x central field
x burn spread–> foveal burn/blind spot
panretinal photocoagulation
x cannot drive
x peripheral field
x night vision
x painfull
sx in DM indications
VITRECTOMY
- persistent VH
- tractional RD
intravitreal veg-f for maculopathy
- decrease edema
- increase vision
intravitreal veg-f for retinopathy
- regress new vessels
- clear VH
combined laser and intravitreal tx DM
- DIABETIC MACULAR EDEMA– diffuse OR focal
- PROLIF.D.R.– with VH or DME
background DR
microaneurysms
dot and blot haemorrhages
retinal edema
hard exudates
micro aneurysms are secondary to….
proliferation of pericytes
preproliferative DR
cotton wool spots intra-retinal microvascular abnormalities venous changes extensive RHs arterial changes
cotton wool spots
secondary to impaired axonal transport–> ischaemia
TEMPORARY
intra-retinal microvascular abnormalities
arteriolar-venular shunts
capillary occlusion adjacent
venous changes
sausaging/beading
omega sign
arterial changes
attenuation of vessels