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RETINA ANAMOLIES DX/WU/TX > RETINA - VITREOUS-RETINA INTERFACE SPLITTING > Flashcards

RETINA - VITREOUS-RETINA INTERFACE SPLITTING Flashcards

1
Q

what are 3 types of retinal breaks?

A
  1. horseshoe tear
  2. operculated hole
  3. atrophic hole
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2
Q

what is a horseshoe tear?

A

It is a full thickness retinal break/defect caused by vitreoretinal traction - An overlying flap is present because of uneven vitreous traction.

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3
Q

where is the most common location for a horseshoe tear to occur?

A
  1. superior temporal
  2. superior nasal
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4
Q

what is an operculated hole?

A
  • 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).
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5
Q

what is an atrophic hole?

A
  • It’s a round, often small, full-thickness defect that are caused by chronic atrophy of the sensory retina.
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6
Q

where is the most common location for a atrophic tear to occur?

A
  1. superior temporal
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7
Q

what retinal break has a higher chance of causing a retinal detachment?
* list the retinal breaks in order of greatest to least

A

horseshoe > operculum > atrophic

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8
Q

what is the % chance a horseshow tear will cause an RD?

A

30-50%

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9
Q

why does a horseshoe tear have a higher chance of causing a RD?

A

b/c vitreoretinal traction remains after the tear occurs

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10
Q

why is an operculated hole less likely to cause a RD?

A

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.

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11
Q

what is a RD?

A

detachment of the sensory (neural) retina from the RPE?

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12
Q

what are the 2 type of broad retinal detachment categories?

A
  1. rhegmatogenous RD
  2. non-rhegmatogenous RD
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13
Q

what are rhegmatogenous RD caused by?

A

these are caused by V-R traction which leads to a retinal break (horseshoe tear, operculum, atrophic hole).

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14
Q

who gets retinal breaks/RRD?

A
  • M>F
  • > 45y/o
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15
Q

what are the risk factors for retinal break/RRD?

A
  • high Myopia (40%)
  • FHx
  • PVD (10-15%)
  • Trauma (5-10%)
  • Ocular Sx
  • Lattice degeneration (1%)
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16
Q

what are symptoms of RB/RRD?

A
  • flashes
  • floaters that move w/ eye movment
  • curtain/veil in vision
  • missing areas of vision
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17
Q

what are signs of RD?

A

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)

18
Q

Tx for RRD?

A

macula off:
* urgent (24-72 hrs) referral

macula on:
* emergent (same day) referral

Surgical Tx –> laser photocoagulation (PRP)/cryotherapy/penumatic retinopexy/vitrectomy/scleral buckle

19
Q

Tx for retinal break (RB)?

A

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.

20
Q

what are the 2 types of non-rhegmatogenous RD?

A
  1. serous RD
  2. tractional RD
21
Q

why are serous and tactional RD consider non-rhegamtogenous?

A

these are not caused by a retinal tear or hole.

22
Q

define serous RD.

A
  • Type of RD that results from subretinal disorders that damage the BRB (RPE) and allow fluid to accumulate under the retina (subretinal space).
23
Q

what is the cause of serous RD?

A

caused by systemic disease:
* CHBALA
* CSR
* Coat’s Dz
* choroidal melanoma
* optic pit
* morning glory syndrome

24
Q

what is tractional RD?

A

Its neovascularization that grows from retina to vitreous. This causes traction between retina and vitreous

25
Q

how does tractional RD occur?

A

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.

26
Q

what causes tractional RD?

A

any disease that can cause neovascularization (DR.VOS):
* DM
* ROP
* vascular occlusion
* OIS
* sickle cell retinopathy

27
Q

tx for tractional RD?

A

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.

28
Q

what is retinoschisis?

A

It is splitting of the layers within the retina.

29
Q

what layers are split in retinoschisis?

A

the OPL & INL

30
Q

what location does retinoschisis commonly occur?

A

inferior-temporal retina

31
Q

what are the 2 forms of retinoschisis?

A
  1. congential juvenile x-linked recessive
  2. acquired are related
32
Q

define juvenile x-linked retinoschisis.

A

Juvenile retinoschisis is characterized by bilateral maculopathy with associated peripheral retinoschisis in 50%.

33
Q

where does splitting occur in juvenile x-linked recessive retinoschisis?

A

splitting occurs in the NFL.

34
Q

what type of maculopathy is associated with congenital retinoschisis?

A

Foveal schisis seen as stellate maculopathy - spoke like foveal cysts.

35
Q

signs of congenital retinoschisis?

A
  • nystagmus
  • vit heme
  • pigmentary changes may also occur.
  • Pigmented demarcation lines can be seen (indicating previous RD
36
Q

define acquired age related retinoschisis.

A

bilateral and symmetrical splitting occurs at OPL.

37
Q

what is the work-up done for retinoschisis?

A
  • DFE w/scleral depression
  • OCT to determine layers of separation.
38
Q

tx for retinoschisis?

A
  • no tx for retinoschisis.
  • vitrectomy - for vitreous heme.
  • amblyopia prevention
  • congenital retinoschisis - edu child to avoid physical activity to prevent RD or hemes.
39
Q

when do you want to see retinoschisis patient back?

A

6 months

40
Q

what type of VF defect does retinoschisis produce? How about RD?

A
  • absolute VF defect
  • RD - relative VF defect

RETINA ANAMOLIES DX/WU/TX (11 decks)

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