RETINA - VITREOUS-RETINA INTERFACE SPLITTING Flashcards
what are 3 types of retinal breaks?
- horseshoe tear
- operculated hole
- atrophic hole
what is a horseshoe tear?
It is a full thickness retinal break/defect caused by vitreoretinal traction - An overlying flap is present because of uneven vitreous traction.
where is the most common location for a horseshoe tear to occur?
- superior temporal
- superior nasal
what is an operculated hole?
- It is a symmetrical retinal tear resulting from an even vitreoretinal traction that pulls piece of the retinal tissue - the overlying piece of tissue is called an operculum (smaller than the tear).
what is an atrophic hole?
- It’s a round, often small, full-thickness defect that are caused by chronic atrophy of the sensory retina.
where is the most common location for a atrophic tear to occur?
- superior temporal
what retinal break has a higher chance of causing a retinal detachment?
* list the retinal breaks in order of greatest to least
horseshoe > operculum > atrophic
what is the % chance a horseshow tear will cause an RD?
30-50%
why does a horseshoe tear have a higher chance of causing a RD?
b/c vitreoretinal traction remains after the tear occurs
why is an operculated hole less likely to cause a RD?
After forming the tear, the vitreous pulls away and the vitreoretinal traction no longer persist –> this reduces the risk for a retinal detachment to occur.
what is a RD?
detachment of the sensory (neural) retina from the RPE?
what are the 2 type of broad retinal detachment categories?
- rhegmatogenous RD
- non-rhegmatogenous RD
what are rhegmatogenous RD caused by?
these are caused by V-R traction which leads to a retinal break (horseshoe tear, operculum, atrophic hole).
who gets retinal breaks/RRD?
- M>F
- > 45y/o
what are the risk factors for retinal break/RRD?
- high Myopia (40%)
- FHx
- PVD (10-15%)
- Trauma (5-10%)
- Ocular Sx
- Lattice degeneration (1%)
what are symptoms of RB/RRD?
- flashes
- floaters that move w/ eye movment
- curtain/veil in vision
- missing areas of vision
what are signs of RD?
Acute:
* schaeffer’s sign - in vitreous
* ripples in retina
* horseshoe tear/operculum
* macula on or off
Longstanding:
* pigment demarcation line at detachment sight (works as a seal)
Tx for RRD?
macula off:
* urgent (24-72 hrs) referral
macula on:
* emergent (same day) referral
Surgical Tx –> laser photocoagulation (PRP)/cryotherapy/penumatic retinopexy/vitrectomy/scleral buckle
Tx for retinal break (RB)?
acute - urgent (24-72 hrs) referral for laser photocoagulation or cryotherapy.
chronic - monitor yearly with DFE and fundus photos. Educate pt of s/s of RD.
what are the 2 types of non-rhegmatogenous RD?
- serous RD
- tractional RD
why are serous and tactional RD consider non-rhegamtogenous?
these are not caused by a retinal tear or hole.
define serous RD.
- Type of RD that results from subretinal disorders that damage the BRB (RPE) and allow fluid to accumulate under the retina (subretinal space).
what is the cause of serous RD?
caused by systemic disease:
* CHBALA
* CSR
* Coat’s Dz
* choroidal melanoma
* optic pit
* morning glory syndrome
what is tractional RD?
Its neovascularization that grows from retina to vitreous. This causes traction between retina and vitreous
how does tractional RD occur?
occurs when neovascularization from the retina grows into the vitreous causing the two to be “connected.” This creates potential for traction to occur everytime the vitreous contracts/moves.
* If the vitreous breaks the neovascular blood vessels –> it will lead to pre-retinal heme.
* If the vitreous tears —> neo blood vessels also rip and this causes vitreous heme.
* If the retina tears –> then fluid can accumulate underneath the retina leading to a tractional RD.
what causes tractional RD?
any disease that can cause neovascularization (DR.VOS):
* DM
* ROP
* vascular occlusion
* OIS
* sickle cell retinopathy
tx for tractional RD?
same as RRD:
acute - urgent (24-72 hrs) referral for PRP or cryotherapy.
chronic - monitor yearly with DFE and fundus photos. Educate pt of s/s of RD.
what is retinoschisis?
It is splitting of the layers within the retina.
what layers are split in retinoschisis?
the OPL & INL
what location does retinoschisis commonly occur?
inferior-temporal retina
what are the 2 forms of retinoschisis?
- congential juvenile x-linked recessive
- acquired are related
define juvenile x-linked retinoschisis.
Juvenile retinoschisis is characterized by bilateral maculopathy with associated peripheral retinoschisis in 50%.
where does splitting occur in juvenile x-linked recessive retinoschisis?
splitting occurs in the NFL.
what type of maculopathy is associated with congenital retinoschisis?
Foveal schisis seen as stellate maculopathy - spoke like foveal cysts.
signs of congenital retinoschisis?
- nystagmus
- vit heme
- pigmentary changes may also occur.
- Pigmented demarcation lines can be seen (indicating previous RD
define acquired age related retinoschisis.
bilateral and symmetrical splitting occurs at OPL.
what is the work-up done for retinoschisis?
- DFE w/scleral depression
- OCT to determine layers of separation.
tx for retinoschisis?
- no tx for retinoschisis.
- vitrectomy - for vitreous heme.
- amblyopia prevention
- congenital retinoschisis - edu child to avoid physical activity to prevent RD or hemes.
when do you want to see retinoschisis patient back?
6 months
what type of VF defect does retinoschisis produce? How about RD?
- absolute VF defect
- RD - relative VF defect
