Posterior Segment (F) Flashcards
What are the stages of Best’s Vitelliform Dystrophy?
- Subnormal EOG but no retinal signs
- Pigment mottling
- Sunny-side up egg in the macula
- Lesion starts to reabsorb
- Scrambled egg – visual acuity drops
- Atrophy
What is the treatment for retinopathy of prematurity?
- Stages 1 & 2: No treatment necessary; 80-90% regress
- Stage 3: Laser photocoagulation
- Stage 4 & 5: Surgical repair of retinal detachment by scleral buckle, vitrectomy or both.
What are the signs of X-linked (juvenile) Retinoschisis?
o Macular spokewheel pattern o 50% can have peripheral schisis (IT)or RD o ERG: Reduced b-wave and normal a-wave o Visual acuity variable (20/60-20/200) o Presents between 5-10 years of age
What is the retinal appearance of a child with anemia? 1. What are the symptoms? 2
- intraretinal heme, cotton wool spots
2. lethargy and pallor
What is the retinal appearance of an abused child? 1. What are the possible causes? 2
- retinal hemes
- Shaken Baby Syndrome (IF SEE RETINAL HEMORRHAGES IN A CHILD YOUNGER THAN 4 – MUST CONSIDER ABUSE) or hemes caused by birth, falls or accidents
What is the retinal appearance of a child with diabetic retinopathy? 1. How does this DR in children compare to DR in adults? 2
- dot/blot hemes, exudates, cotton wool spots
2. much faster and more severe
What is the most common intraocular malignancy in children? 1. When does diagnosis usually occur? 2. What is the prognosis? 3
- retinoblastoma
- 18 months
- over 90% survival
What presents as reddish to orange tumors of the choroid? 1. What is the treatment? 2
- choroidal hemangioma
2. laser if affecting vision or causing retinal detachment
What is the visual sequelae of current treatment of retinopathy of prematurity?
o High myopia o Reduced peripheral vision o Reduced central visual acuity (macular dragging) o Strabismus and amblyopia o Cataracts
What are the signs of retinopathy of prematurity?
o Avascular peripheral retina
o Dilated, tortuous retinal vessels (“plus”)
o Poor dilation
o Engorged iris vessels
o Typically bilateral
o Neovascularization, hemorrhage, RD, leukocoria
What are the signs of optic nerve hypoplasia?
o Small optic nerve surrounded by ‘double ring sign’
o Inner ring is CR atrophy
o Outer ring is edge of what would have been the normal disc margin
o Disc-macula: Disc Diameter (DM:DD): If ratio is > 3:1 then hypoplastic
What are the five primary posterior segment signs of involvement in children?
o Leukocoria o Macular problems o Optic nerve problems o Tumors o Retinal hemorrhages
What are the possible causes of leukocoria in children?
o Cataract o PHPV o Coats Disease o Toxocariasis o Posterior Uveitis o Late stage ROP o Late stage Coats o Late stage toxocariasis o Retinoblastoma
What are the signs of Stargardt’s Disease?
o Progressive loss of vision to 20/200
o Fovea shows non-specific mottling
o Progression to “beaten bronze” appearance
o Can be surrounded by yellow/white flecks (fundus flavimaculatus if seen in adult presentation)
o Eventually, geographic atrophy
o FANG shows ‘dark choroid’
What is the condition with the absence of the septum pellucidum and agenesis of the
corpus callosum?
Septo-optic dysplasia (deMorsier Syndrome)
What is the condition marked by retinal telangiectasias with intraretinal and subretinal exudation that can lead to exudative retinal detachment? 1. What is the epidemiology? 2. What is the management? 3
- Coats disease
- 75% male, unilateral
- catch before RD, neo glaucoma, laser if telangiectasias, cryotherapy for RD
What is the retinal appearance of a child with leukemia? 1. What is the most common type of childhood leukemia? 2. What are the symptoms of that leukemia? 3
- Intraretinal heme, Roth’s spot, cotton wool spots, tortuous and dilated vessels
- Acute Lymphocytic Leukemia
- petechial hemes, pallor, fever, bruising, infection, joint pain
What are the zones that are used for localization of retinopathy of prematurity?
- Zone 1 – Radius around the optic nerve equal to twice distance from disc to macula
- Zone 2 – Radius from optic nerve to nasal ora serrata
- Zone 3 – Residual temporal crescent anterior to zone
What are the signs and treatment of Best’s Vitelliform Dystrophy?
o Onset before driving age o VA can remain 20/40 to 20/200 o Tritan defect o Normal ERG, reduced EOG o Genetic counseling and vision rehab
What is the examination schedule for a patient with retinopathy of prematurity if less than 2 lb 12 oz?
q2wk until 14 weeks
q1mo until 6 months
q6mo thereafter
What is an incomplete development of the vitreous result in? 1. What are the associated conditions of the eye? 2. What is the management? 3
- Persistent Hyperplastic Primary Vitreous (PHPV)
- Microphthalmia, microcornea, whitish vascularized membranes behind lens, vitreous membranes, retinal folds
- refer for lensectomy and vitrectomy
What are the treatment options for retinoblastoma?
o Enucleation o Radiation o Cryotherapy o Photocoagulation o Chemotherapy
What are the stages of severity for retinopathy of prematurity?
- Stage 1: flat tortuous marked line between vascular and avascular retina
- Stage 2: elevated ridge line
- Stage 3: elevated ridge line with fibrovascular proliferation
- Stage 4A: retinal detachment with macula on
- Stage 4B: retinal detachment with macula off
- Stage 5: total retinal detachment
- Plus Disease (Dilated, tortuous vessels, retinal hemorrhages)
What are the risk factors for retinopathy of prematurity?
- Birth less than 36 wks gestation
- birthweight less than 1500g (3 lb 5 oz), especially under 1250g (2 lb 12 oz)
- supplemental oxygen therapy
