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PPO > other other macular disorders > Flashcards

other other macular disorders Flashcards

1
Q

what is the peripheral retina

A

anterior to the equator, extending to the oraserrata (3dd away)

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2
Q

the peripheral retina encompasses what percentage of the fundus

A

40%

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3
Q

what changes occur with blood vessels in the peripheral retina

A

smaller
fewer
become basically parallel to ora

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4
Q

the ora is more scalloped on which side

A

nasally

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5
Q

what are oral bays

A

they are extensions of pars plana at the ora serrata

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6
Q

what are oral teeth (dentate processes)

A

extensions of retina between oral bays

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7
Q

oral bays and teeth together are called what

A

dentate processes

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8
Q

migraine headaches cause flashes that last for how long? unilateral or bilateral?

A

flashes usually last 10-60 minutes
usually unilateral
start central, move peripheral

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9
Q

if flashes occur from vitreal or retinal causes, how long do they last

A

only a few seconds, usually provoked by head movement. usually acute and sudden onset.

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10
Q

what kind of questions do you want to ask someone with floaters

A 
how long have the floaters been present
which eye
how many
whats the shape
what their story: trauma, disease, inflammation, etc.
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11
Q

what are some differentials for floaters

A
  1. pbd
  2. vitreal heme
  3. retinal operculum
  4. entoptic = gazing in sky, small white particles are white blood cells
  5. posterior uveitis
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12
Q

what could cause pseudo flashes

A

medical history,
media opacities
glare

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13
Q

what is another word for peripheral RPE degeneration

A

reticular degeneration

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14
Q

what is peripheral RPE degeneration and what is the prevalence

A

granular pigment deposits between the ora and the equator and 20% of population over 40

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15
Q

what causes peripheral RPE degeneration

A

caused by the break down of the RPE with deposition of pigment granules in sensory retina. ultimately loss of PRs and sclerosis of the choriocapilaris

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16
Q

how do you manage / treat peripheral RPE degeneration

A

monitor routine dilation every 1-2 years

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17
Q

what causes paving stone / cobble stone degeneration

A

occlusion of compartments of choriocapilaris which causes RPE degeneration and retinal thinning

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18
Q

pavingstone degeneration is common in what populations

A 
age related (greater than 40)
usually benign
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19
Q

paving stone degeneration is common in what quadrants

A

nasal and temporal quadrants

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20
Q

where is pavingstone degeneration located

A

located between ora and equator

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21
Q

describe the apparance of lesions in pavingstone

A

flat

distinct margins that may have pigmented edges that are several dd in size

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22
Q

what is the management of pavingstone degeneration

A

monitor and routine dialation every 1-2 years

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23
Q

how common is peripheral cystoid degeneration

A

occurs in virtually all patients over the age of 8

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24
Q

what causes peripheral cystoid degeneration

A

involves cystoid like changes in OPL that can extend to involve the entire sensory retina

if the cyst colalesce they can form large cystoid spaces, causing true splitting or retinoschisis of the sensory retina

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25
Q

where is peripheral cystoid degeneration found and what does it look like

A

usually at ora and can extend to the equator

thickened area of retina, extending about 1/2 dd

26
Q

how do you manage peripheral cystoid degeneration

A

just monitor and routine dialation every 1-2 years

27
Q

t/f cystoid degeneration is a risk for developing retinal detachments

A

false

28
Q

t/f white WITH pressure is a malignant condition

A

false

29
Q

what causes white WITH pressure

A

a distinct milky white appearance when scleral depression is performed. without depression the retina appears normal

its commonly observed in approx 30% of eyes examined with scleral depression, and is NOT associated with peripheral retinal breaks

30
Q

white without pressure is usualyl seen in what kind of eyes

A

10x more often in darker fundi
higher incidence in myops.
associated with aging

31
Q

what is the cause of white without pressure

A

unusual vitreal-retinal relationship that causes disorganization of NFL of sensory retina down to RPE

32
Q

where does white without pressure occur

A

occurs between the ora and the equator

33
Q

t/f white without pressure can lead to retinal detachments

A

true

its associated with abnormal vitreal-retinal adhesion

34
Q

what is schaffer’s sign

A

its presence of cells that are golden brown pigmented granules and anterior vitreous of phakic that suggests retinal breaks. sometimes called tobacco dust.

35
Q

atrophic retinal holes are usually secondary to what

A

progressive retinal thinning due to underlying vascular insufficiency

36
Q

atrophic retinal holes are usually about how big

A

pinpoint to 2 dd round red lesions

37
Q

atrophic hole surrounded by pigment or RPE hyperplasia indicate what

A

indicates lesion has been prsent for approx 3 months

38
Q

about how often do you get sensory retinal detachment from atrophic retinal holes

A

10% incidence

39
Q

how to manage / treat atrophic retinal holes

A

if there is pigment around it, monitor it annually.
if there is a cuff of adema, refer to OMD
patient education.
risks of retinal detachment

40
Q

operculated retinal holes appear where and appear how

A

usually occur from equator to ora

round, red, holes with a free floating plug of retinal tissue attached to the vitreous

41
Q

what causes horseshoe tears

A

usually due to abnormal vitreal-retinal adhesions and PVD

42
Q

horse shoe tears put you at risk for what two things

A
  1. retinal detachment

2. vitreal hemes

43
Q

how do you manage horse shoe tears

A

refer all horse shoe tears to a retinal specialist because they cause 30% of retinal detachments

44
Q

lattice degeneration is what, found where, how many people have it

A

oval or elliptical area of retinal thinning near the equator found in approx 8% of the population

45
Q

what causes lattice degeneration

A

a vitreal retinal degeneration affecting inner retinal layers and vitreal retinal surface

46
Q

lattice degeneration is more commonly found in what quadrants and what size/appearance

A

usually found superior or inferior quadrants.
usually parallel to ora serrata
usually 2dd to a full quadrant in size
1/2 dd to 1.5 dd in width
looks like fine white lines that look attenuated or sheathed vessels with some RPE hyperplasia changes
vitreous liquefies over lattice

47
Q

what is snail tracking degeneration

A

basically the same as lattice degeneration but looks like a whiteish trail instead.

48
Q

what are vitreal retinal tufts

A

accumulation of proliferated glial cells on retinal surface causing retinal degeneration and subsequent vitreous attachment

49
Q

vitreal retinal tufts are found where and what do they look like

A

found between equator and ora, usually nasal

look like grayish white pieces of tissue

50
Q

what is a complication of vitreal retinal tufts

A

retinal detachment or tears may occur with vitreous liquefaction

51
Q

where is retinal dialysis found if associated with trauma vs spontaneously

A

trauma = mostly in superior nasal quadrant

spontaneous in younger patients = inferior temporal quadrant and bilateral

52
Q

what is the definition of retinal dialysis

A

its a retinal tear that occurs near the ora serrata that looksl ike a slow progressing retinal detachment

53
Q

what is the treatment for retinal dialysis

A

refer all dialysis; needs prompt treatment

54
Q

what are some causes for rhegamatogenous retinal detachments

A

20% caused by lattice
20% caused by blunt trauma
high myopia

55
Q

what is a non-rhegamatogenous retinal detachment

A

a definition has no loose end to a retinal break and often a sign of a space occupying lesion, like a tumor

56
Q

what are the two types of acquired retinoschisis

A 
flat = typical
bullous = reticular
57
Q

what is retinoschisis

A

splitting of sensory retina, outer plexiform and inner nuclear layer

58
Q

with acquired retinoschisis, where is it usually found; uni or bilateral

A

usually bilateral, and found typically in inferior temporal quadrant

59
Q

what is flat RS

A

believed to represent advanced cystoid degeneration, usually not associated with retinal holes.

60
Q

what is bulluos RS, what does it look like, what is the cavity filled with

A

looks like thin transparent ballooning forward of retinal tissue
cavity is filled with hyaluronic acid
posterior edge may be serrated, but typically has no pigmented line
progression is rare.

61
Q

what is one possible complication of bullous RS

A

11% of patients with RS will develop retinal detachments

62
Q

besides retinal detachments, what are some other complications of RS

A

can get multiple inner retinal holes or outer retinal holes that are larger than inner retinal holes, and typically only one.

PPO (10 decks)

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