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Medical Retina > Retinal Breaks And Detachment > Flashcards

Retinal Breaks And Detachment Flashcards

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USMLE® Step 1 flashcards
1
Q

How much of the eye does the vitreous occupy and how much % is made up of water

A

Occupies ~80% of eye

98% water

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2
Q

The nasal ora serrata has more…

A

teeth compared to the temporal side - which provides better adhesion

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3
Q

what is the Interphotoreceptor matrix

A

the ‘glue’ between RPE and photoreceptors

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4
Q

there is osmotic pressure between the vitreous and…

A

the choroid

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5
Q

what is the Primary cause of retinal breaks and retinal detachment

A

posterior vitreous detachment

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6
Q

how does a pvd cause a retinal break

A

Traction induces retinal breaks, vitreous currents result in RD

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7
Q

what is the NICE guidance: Management of suspected retinal detachment from August 2019

A

Immediate/same day referral if
• Visual loss
• Vitreous haemorrhage or retinal detachment

Urgent referral (within 24 hours)
• To a practitioner competent in the use of slit-lamp examination and indirect ophthalmoscopy to be seen within 24 hours
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8
Q

under what 5 conditions can you manage a patient in your practice if you confirm they have a PVD after dilated ocular examination

A

vision is unchanged

no retinal tear or detachment is present

no pigment is present in the anterior vitreous

the patient is well informed about what symptoms to expect if the retina does break or detach subsequently, and

you issue the patient with written information to support your diagnosis and advice

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9
Q

list 4 reasons for an emergency referral

A

retinal detachment

pigment in the anterior vitreous (tobacco dust)

vitreous, retinal or pre-retinal haemorrhage, or

lattice degeneration or retinal break, with symptoms

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10
Q

Approx ___% of patients with symptoms of F/F have retinal break and ___% of these breaks will progress to RD

All patients with such symptoms should have…

A

Approx 25% of patients with symptoms of F/F have retinal break and 50% of these breaks will progress to RD

All patients with such symptoms should have 360 indentation ophthalmoscopy

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11
Q

list 5 predisposing factors of a PVD

A 
Age 
Refractive error 
Gender 
Contralateral eye affected 
Trauma and surgery
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12
Q

what is the Mean age of onset of a pvd

A

60-65 years

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13
Q

how does refractive error affect the onset of a pvd

A

5-10 years earlier in myopia

5-10 years later in hyperopia

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14
Q

how is gender a predisposing factor of a pvd

A

Male : Female ratio 2:3

females are more likely to seek medical attention

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15
Q

how is a contralateral affected eye a predisposing factor of a pvd

A

2nd eye involvement in 80-90% within 2-3 years

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16
Q

what type of photopsia does a person suffering from a pvd experience in comparison to a person suffering from a retinal detachment

A

Temporal field - White Flash with PVD

any other field associated with RD - can be coloured

Each episode lasts 1 sec or less
Resolve after 4-6 months

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17
Q

what 3 things can cause floaters in a PVD or RD

A

Aggregation of collagen fibrils
Blood
Pigment

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18
Q

an improvement in photopsia or floaters does not exclude…

A

presence of retinal breaks

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19
Q

how many stages are there to a PVD

A

5

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20
Q

what is stage 0 of a pvd

A

No detachment of cortex

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21
Q

describe stage 1 of a pvd

A

<50% Perifoveal detachment with foveal and peripapillary (ONH) adhesion

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22
Q

describe stage 2 of a pvd

A

50%+ Perifoveal detachment with foveal and peripapillary (ONH) adhesion

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23
Q

describe stage 3 of a pvd

A

Complete foveal detachment with peripapillary adhesion

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24
Q

describe stage 4 of a pvd

A

Complete foveal and peri-papillary detachment

only a small attachment on the ONH

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25
Q

describe stage 5 of a pvd

A

Complete PVD (Papillary detachment)

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26
Q

what is this

what 3 things can this be mistaken for

which 3 types of patients is it more common in

A

Vitreoschisis - splitting within the vitreous itself

PVD, ERM, VMT

Younger age, myopes, diabetic

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27
Q

what 4 signs do you look out for when examining a px with pvd/RD symptoms

A

Pigment in anterior vitreous

IOP

RAPD

Weiss opacity

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28
Q

which type of eyes is pigment in the anterior vitreous only applicable to when looking for signs of a RD

A

Only applicable to phakic eyes without previous trauma

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29
Q

what type of IOP should to look out for when suspecting a RD and how can this be contradictory

A

can be reduced if at least 1 quadrant detached (but can be
elevated!!!)
as broken photoreceptors migrate and block the trab meshwork - causing to be to elevated

30
Q

what sign of the pupils should you look out for when suspecting a RD and what causes this

A

RAPD

if at least 1 quadrant detached, or when the macula is involved

31
Q

what stage of pvd is a weiss opacity only seen in and in how many % of cases is it absent in

A

Only confirms vitreo-papillary separation and not peripheral vitreo-retinal separation

absent in 7-14%

32
Q

how much sensitivity does a 78D and a 90D volk lens have in detecting a pvd or RD

A

78D - 40%

90D - 85%

33
Q

how much sensitivity does a 3 mirrored lens have in detecting a pvd or RD

A

40-87% sensitivity

34
Q

what is the gold standard viewing method in detecting a RD

A

BIO with indentation

35
Q

how much of the retina is the FOV limited to when viewing with a volk lens

A

upto 124 degrees with a digital wide field

36
Q

what is the sensitivity of an optimap in detecting a retinal break and a retinal detachment

A

33% to 70%
(vs 67% for examination)

90 -100% for RD

37
Q

how many % of Operculated breaks progress into a RD

A

15%

38
Q

how many % of a Horseshoe tear progresses into a RD

A

30-60%

39
Q

what is the risk of progression into a RD if a tear is <1DD vs >1DD

A

<1DD ~5% risk

> 1DD 30% risk

40
Q

what is RD pigmentation a sign of and what does it not imply

A

sign of chronicity and does not imply adhesion

41
Q

what are the 2 most common locations of a retinal break

A

infero-temporal

supero-nasal

42
Q

which area of the eye is associated with multiple breaks and which with a solitary break

A

Inferior nasal - multiple breaks

Supero temporal - solitary breaks

43
Q

list 5 tx options for a RD

A 
Cryotherapy
Laser
Scleral buckling
Vitrectomy
Pneumatic
44
Q

how does Cryotherapy work at treating a RD

A

a cyroprobe freezes the retina - delivered via the sclera

45
Q

what is an immediate affect of cryotherapy and how does this gradually change

A

Immediate oedema of all layers and choroidal congestion

By day seven oedema resolves and congestion absorbs, mild lesions show retraction, firm chorioretinal adhesion

retina becomes half of it’s pre tx thickness

46
Q

which types of breaks is it easier to treat with cryotherapy

A

anterior breaks

47
Q

what can cryotherapy result in

A

ERM

due to proliferation of RPE cells

48
Q

how does laser work in repairing a retinal break

A

Energy absorbed by RPE (and haemoglobin)

Results in photoreceptor death and proliferation of glial tissue resulting in fibrosis/tissue adhesion

49
Q

what laser temperature results in photocoagulation

A

10-20°C rise

50
Q

what laser temperature will produce immediate and visible burns

A

30-70°C rise

51
Q 
Post-retinopexy
\_\_% weaker at 8 hours
\_\_% of normal strength at 18 hours 
\_\_\_\_% at 24 hours
\_\_\_\_% at 2-4 weeks
A 
Post-retinopexy
– 50% weaker at 8 hours
– 95% of normal strength at 18 hours 
– 140% at 24 hours
– 190% at 2-4 weeks
52
Q

what is the lincoff rule of a Inf RD with equal SRF

A

Break is at 6

53
Q

what is the lincoff rule of a Inf RD with unequal SRF

A

Inferior break on side with higher SRF

54
Q

what is the lincoff rule of a Inferior bullous RD

A

Superior break

55
Q

what is the lincoff rule of a Extensive Inf RD

A

Superior break level with lowest border of SRF

56
Q

what is the lincoff rule of a Subtotal RD

A

Superior break nearest highest border

57
Q

what is the lincoff rule of a Extensive Sup RD

A

Superior break on side with lowest level of SRF

58
Q

what 2 things does does scleral buckling dramatically reduce

A

vitreous traction and intraocular currents

59
Q

how does scleral buckling tamponade a retinal break

A

Vitreous used to tamponade break internally and explant used externally to support retina

60
Q

what other tx is used in conjunction with scleral buckling

A

Retinopexy (Laser/cryo) used in conjunction to seal retinal breaks

61
Q

which tx does not increase incidence of cataract

A

scleral buckling

62
Q

what can scleral buckling affect

A

refractive error; induce astigmatism and myopia

63
Q

when is scleral buckling tx best utilised

A

when PVD not present and patients without lens opacity

64
Q

how does a vitrectomy work to tx a RD

A

Eliminating vitreous traction

65
Q

which type of px is a victrectomy primary used in for treating a RD

A

in pseudophakic eyes with PVD

66
Q

what other surgery can a vitrectomy be combined with

A

cataract surgery

67
Q

which 3 types of internal tamponades can a vitrectomy procedure be combined with and what is each one for

A

Gas (or air) for superior breaks

Heavy liquid for inferior breaks

Silicone oil for long-term tamponade

68
Q

what is the redetachment rate with scleral buckling

A

25%

69
Q

what is pneumatic retinopexy and what are the advantages of this procedure

A

Gas used to support retina

Can be done as outpatient procedure and does not need specialist theatre equipment or specialist surgeon

Reduced incidence of cataract formation

Quicker recovery

70
Q

what are the 3 inclusions that apply to pneumatic retinopexy

A

A singe retinal break or group of breaks, no larger than one clock hour (30 deg) in a detached retina

All breaks in detached retina to lie above the 8 and 4 o’clock meridian

Breaks or lattice degeneration in attached retina at any location (even inferior) allowed

71
Q

what is the success rate of pneumatic retinopexy vs a vitrectomy

A

80% vs 93% for vitrectomy

72
Q

which treatment of RD has a better VA outcome and which has a higher incidence of cataract surgery for pneumatic retinopexy vs vitrectomy

A

pneumatic retinopexy has a better VA outcome

higher cataract surgery for vitrectomy

Medical Retina (17 decks)

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