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Retina > Retina > Flashcards

Retina Flashcards

1
Q

Layers of Bruch’s membrane

A
  1. RPE basement membrane
  2. Collagen
  3. Elastic tissue
  4. Collagen
  5. Basement membrane of choriocapillaris
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2
Q

Areas of adhesion between choroid and sclera

A

ONH, SS, EXIT point of vortex veins, Long and short posterior ciliary vessels

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3
Q

Areas of adhesion between retina and vitreous

A

Optic nerve, vessels, vitreous base, Macula

Also: edges of lattice, chorioretinal scars, enclosed Ora bays

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4
Q

Layers Of choroid

A

Bruch’s membrane, choriocapillaris, stroma, Suprachoroidal space

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5
Q

ERG components

A

A-wave: negative waveform; photoreceptors
B-wave: Muellers and bipolar cells
C-wave: RPE: positive deflection; occurs in dark adapted state
Amplitude: bottom of a to top of b
Implicit time: time from light flash to peak of B
Oscillatory potential: wavelets on ascending b wave of the scotopic and photopic bright flash ERG; generated in middle retinal layers (IPL)

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6
Q 
ERG findings in
a. CRAO
b. CRVO 
c. RP
d. X-linked RP carrier
E. cone dystrophy
A

A. Normal a wave absent b wave
B. Reduced b wave amplitude; prolonged implicit time; reduced b:a wave ratio
C. Early-Reduced amplitude and prolonged implicit time: Late-Extinguished
D. Prolonged photopic b wave implicit time, reduced scotopic b wave amplitude
E. Abnormal photopic and Flicker, normal scotopic

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7
Q 
ERG findings in:
A. JXLR
B. RD
C. MEWDS
D. CSNB
E. congenital rubella
A

A. Normal a wave until late, reduced b, especially scotopic
B. Reduction in amplitude corresponds to extent of detachment
C. Reduced a wave
D. Normal a wave, poor b
E. Normal

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8
Q 
ERG findings:
A. LCA
B. microvasc dz
C. Glc
D. Optic neuropathy
A

A. Flat
B. loss Of oscillatory potential
C. Normal
D. Normal

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9
Q

Normal ERG with abnormal EOG

A

Best disease and carriers, pattern dystrophies, chloroquine toxicity

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10
Q

Abnormal ERG with normal EOG

A

CSNB, X-linked retinoschisis

Occurs with abnormal bipolar region but normal rods

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11
Q

Fluorescein light characteristics

ICG light characteristics

A

A. Absorbs light at 465 to 490 nm; Emits at 520-530 nm

B. Absorbed at 805 nm (IR), Emits at 835 nm (near-IR)

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12
Q

Traumatic retinal breaks (Friedman 338)

A
  1. Dialysis (IT > SN); 10% initially, 80% by 2y
  2. GRT
  3. Flap tear
  4. Tear around lattice

Can also get traumatic MH

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13
Q

DDX CME

A 
DME
Epinephrine 
Pars planitis
RP
Irvine Gass
Vein occlusion
E2 prostaglandin

Other (non-leaking): Nicotinic acid, JXLR, Goldmann-Favre, RP
Other: XRT, vitreous wick, JXT

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14
Q

JXT

A

Type 1: M > F, middle age, on coats’ spectrum
1a: congenital: temp macula, ME & HE
1b: idiopathic, minimal leakage, va >
20/25
Type 2a (most common): m=f, bilateral, symmetric, minimal ME, glistening white dots (singerman spots), right angle venules; can develop RPE hyperplasia, pseudovitelliform Mac degen, ME 2/2 ischemia, 33% c abnl GTT
-FA c leakage, risk of CNV
Type 3: m=f, cap occlusion predominates;
3a: ret only
3b: + CNS vasculopathy

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15
Q

DDX blood in every retinal layer

A

macroaneurysm, AMD, cap hemangioma, tersens, sickle, melanoma, trauma, CNV (rare), CRVO (rare)

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16
Q

Peripheral retinal Degenerations associated with RD/Break

A

Ora Bay
Meridional fold
Meridional complex
Cystic retinal tuft & Zonular traction tuft (Both are types of vitreoretinal tuft; noncystic retinal tufts not a/w RD)
Lattice
Degenerative retinoschisis (only if hole extends to inner retina)

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17
Q

Etiology of choroidal folds

A

2/2 shrinkage of inner choroid or Bruch’s; causes undulations of overlying RPE & outer retina

THIN RPE: Tumors, hypotony, inflammation/idiopathic, neovascular membrane, retrobulbar mass, papilledema, extraocular hardware

18
Q

High risk features in choroidal nevi

A 
Thickness > 2 mm
Fluid
Sx
Orange pigment
Margin < 3 mm from ONH

Other: u/s shadowing, absent halo

19
Q

DDX peripapillary or ppole lesion

A

Pigmented: Nevus, melanoma, melanocytoma, CHRPE, Adenma/adenocarcinoma, BDUMP

Variable or non-pigmented: astrocytoma, choroidal osteoma, combined hamartoma of retina/RPE, mets, RB, SRH, granuloma, posterior scleritis

Vascular: retinal capillary hemangioma, retinal cavernous hemangioma, race owe hemangioma, cavernous hemangioma of choroid (diffuse or circumscribed)

20
Q

Most commonly affected intra ocular structure in leukemia

A

Optic nerve

21
Q

Layer of schisms in JXLR vs senile

A

JXLR- nfl

Senile- opl

22
Q

Cellular rxn when light strikes photoreceptors

A

Dec cGMP, Na channels close

23
Q

Treatable RP variants

A 
Bassen-Kornzweig (abetalipoproteinemia; tx c vit A & E)
Refsum's (inc phytanic acid; restrict animal fats, leafy greens)
Gyrate atrophy (inc ornithine; tx arginine restriction, b6 supp)
24
Q

DDX eye problems and hearing loss

A

RP (H-CAUL): hallgrens, cockayne, alstroms, ushers, Laurence-moon-bardet-beidl

Cogans, sticklers, waardenberg, duanes, rubella

25
Q

Laurence-moon-bardet-beidl

A

LMBB: pigmentary ret c flat ERG, MR, hypogonadism, short stature
LM spastic paraplegia
BB polydactyly, obesity

26
Q

Describe:
Alstrom’s
Cockayne’s
Batten’s

A

Alstrom’s: deafness, diabetes
Cockayne’s: Deafness, dwarfism/Premature aging
Batten’s: Seizures, ataxia

27
Q

CSNB symptoms

A

Normal VA, VF and color VA
Nyctalopia with no purkinje shift
Paradoxical pupils
ERG: identical implicit times in photopic/scotopic; dec scotopic with almost nl photopic

28
Q

CSNB subtypes

A

Normal fundus: Nougaret, Riggs, Schubert-Bornschein

Abnormal fundus:

  1. fundus albipunctatus (AR, but Alports is AD)
  2. Oguchi’s (XLR)
  3. Fleck retina of Kandori
29
Q

Goldmann-Favre inheritance & findings

A

AR
Like RP + JXLR: optically empty vit, b/l central and periph schisis, periph bone spicules (more nummular), lattice

Erg: reduced

30
Q

Peds VR degenerations

A

Wagner (AD): optically empty vit, lattice-like changes, myopia, cataract, no RD

Jansen (AD): Wagner + RD

Stickler (AD): Wagner + rd (50%) + high myopia, marfanoid habitus, Pierre-Robin sequence, pigmentary ret

31
Q

Incontinentia pigmenti

a. Inheritance
b. retinal Findings
c. Skin Findings

A

A. X linked dominant (Lethal in males)
B. Proliferative retinal vasculopathy resembling ROP; may have RD and retrolental membrane
C. Bullae at birth, verrucus lesions by two months, pigmented whorls by six months, atrophic skin with hypopigmented patches later.

32
Q

Optic nerve drusen associations

A

Angioid streaks, RP, Alagille’s syndrome

33
Q

Decrease in risk of DR by decreasing A1c by 1%

A

30%

34
Q

Ratio of rod:cone

A

20:1 (MEEI)

35
Q

Rod and cone parts

A

Both are made of synaptic body (rod: spherule; cone : pedicle); IS and OS

rods: pigment discs of OS NOT attached to cell membrane
cones: pigment discs ARE attached

36
Q

Ret breaks after trauma

A 
IT dialysis
SN dialysis
GRT
Flap tear
Tear around lattice

See chern retina #63, pg 518-19

37
Q

Inner nuclear layer components

A

INL: Amacrine, bipolar, horizontal, muller
ONL: photoreceptors

38
Q

ROP screening guidelines

A

Screen infants < 1500g or 1500-2000 g c unstable course
First exam at 4 weeks or corrected GA of 30 weeks, whichever is later
(BCSC peds pg 285)

39
Q

Most common bulls eye maculopathy

A

Cone dystrophy

40
Q

Aicardi syndrome triad

A

chorioretinal lacunae, infantile spasms, agenesis of corpus callosum

Retina (1 decks)

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