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III. Vision of Children > Posterior Segment (F) > Flashcards

Posterior Segment (F) Flashcards

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1
Q

What are the stages of Best’s Vitelliform Dystrophy?

A
  1. Subnormal EOG but no retinal signs
  2. Pigment mottling
  3. Sunny-side up egg in the macula
  4. Lesion starts to reabsorb
  5. Scrambled egg – visual acuity drops
  6. Atrophy
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2
Q

What is the treatment for retinopathy of prematurity?

A
  1. Stages 1 & 2: No treatment necessary; 80-90% regress
  2. Stage 3: Laser photocoagulation
  3. Stage 4 & 5: Surgical repair of retinal detachment by scleral buckle, vitrectomy or both.
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3
Q

What are the signs of X-linked (juvenile) Retinoschisis?

A 
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
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4
Q

What is the retinal appearance of a child with anemia? 1. What are the symptoms? 2

A
  1. intraretinal heme, cotton wool spots

2. lethargy and pallor

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5
Q

What is the retinal appearance of an abused child? 1. What are the possible causes? 2

A
  1. retinal hemes
  2. Shaken Baby Syndrome (IF SEE RETINAL HEMORRHAGES IN A CHILD YOUNGER THAN 4 – MUST CONSIDER ABUSE) or hemes caused by birth, falls or accidents
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6
Q

What is the retinal appearance of a child with diabetic retinopathy? 1. How does this DR in children compare to DR in adults? 2

A
  1. dot/blot hemes, exudates, cotton wool spots

2. much faster and more severe

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7
Q

What is the most common intraocular malignancy in children? 1. When does diagnosis usually occur? 2. What is the prognosis? 3

A
  1. retinoblastoma
  2. 18 months
  3. over 90% survival
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8
Q

What presents as reddish to orange tumors of the choroid? 1. What is the treatment? 2

A
  1. choroidal hemangioma

2. laser if affecting vision or causing retinal detachment

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9
Q

What is the visual sequelae of current treatment of retinopathy of prematurity?

A 
o High myopia
o Reduced peripheral vision
o Reduced central visual acuity (macular dragging)
o Strabismus and amblyopia
o Cataracts
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10
Q

What are the signs of retinopathy of prematurity?

A

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

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11
Q

What are the signs of optic nerve hypoplasia?

A

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

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12
Q

What are the five primary posterior segment signs of involvement in children?

A 
o Leukocoria
o Macular problems
o Optic nerve problems
o Tumors
o Retinal hemorrhages
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13
Q

What are the possible causes of leukocoria in children?

A 
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
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14
Q

What are the signs of Stargardt’s Disease?

A

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’

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15
Q

What is the condition with the absence of the septum pellucidum and agenesis of the
corpus callosum?

A

Septo-optic dysplasia (deMorsier Syndrome)

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16
Q

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

A
  1. Coats disease
  2. 75% male, unilateral
  3. catch before RD, neo glaucoma, laser if telangiectasias, cryotherapy for RD
17
Q

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

A
  1. Intraretinal heme, Roth’s spot, cotton wool spots, tortuous and dilated vessels
  2. Acute Lymphocytic Leukemia
  3. petechial hemes, pallor, fever, bruising, infection, joint pain
18
Q

What are the zones that are used for localization of retinopathy of prematurity?

A
  1. Zone 1 – Radius around the optic nerve equal to twice distance from disc to macula
  2. Zone 2 – Radius from optic nerve to nasal ora serrata
  3. Zone 3 – Residual temporal crescent anterior to zone
19
Q

What are the signs and treatment of Best’s Vitelliform Dystrophy?

A 
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
20
Q

What is the examination schedule for a patient with retinopathy of prematurity if less than 2 lb 12 oz?

A

 q2wk until 14 weeks
 q1mo until 6 months
 q6mo thereafter

21
Q

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

A
  1. Persistent Hyperplastic Primary Vitreous (PHPV)
  2. Microphthalmia, microcornea, whitish vascularized membranes behind lens, vitreous membranes, retinal folds
  3. refer for lensectomy and vitrectomy
22
Q

What are the treatment options for retinoblastoma?

A 
o Enucleation
o Radiation
o Cryotherapy
o Photocoagulation
o Chemotherapy
23
Q

What are the stages of severity for retinopathy of prematurity?

A
  1. Stage 1: flat tortuous marked line between vascular and avascular retina
  2. Stage 2: elevated ridge line
  3. Stage 3: elevated ridge line with fibrovascular proliferation
  4. Stage 4A: retinal detachment with macula on
  5. Stage 4B: retinal detachment with macula off
  6. Stage 5: total retinal detachment
  7. Plus Disease (Dilated, tortuous vessels, retinal hemorrhages)
24
Q

What are the risk factors for retinopathy of prematurity?

A
  1. Birth less than 36 wks gestation
  2. birthweight less than 1500g (3 lb 5 oz), especially under 1250g (2 lb 12 oz)
  3. supplemental oxygen therapy

III. Vision of Children (19 decks)

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