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Retina > Retinal detachment > Flashcards

Retinal detachment Flashcards

1
Q

Important histo features of Lattice

A

varying degrees of atrophy, irregularity of inner layers, overlying pocket of liquefied vitreous, condensation, and adherence of vitreous at the margin of the lesions

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2
Q

When does lattice lead to RDs?

A

When it leads to tractional tears at lateral, posterior, or less commonly an atrophic hole in the lattice zone

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3
Q

In whom does atrophic holes in lattice lead to RDs?

A

young pts with myopic eyes and no PVD

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4
Q

Lesions that predispose eyes to RDs

A

Lattice degeneration, retinal excavations, vitreoretinal tufts, meridional folds, and enclosed ora bays

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5
Q

Vitreretinal tufts

A

small, peripheral focal areas of elevated glial hyperplasia assocaited with vitreous or zonular attachment and traction. They can be non cystic, cystic, or zonular.

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6
Q

What is a meridional fold

A

Folds of redundant retina, usually located SN

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7
Q

Enclosed ora bays

A

oval islands of pars plana epithelium located posterior to ora and completely surrounded by peripheral retina

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8
Q

Retinal excavations

A

Mild form of lattice.

They form firm vitreoretinal adhesions and are found adjacent to or up to 4DD post to ora. Found w meridional folds

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9
Q

Lesions that do not predispose eye to RDs

A

Paving stone (cobblestone), RPE hyperplasia, RPE hypertrophy, peripheral cystoid degeneration

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10
Q

Cobblestone degeneration histo

A

atrophy of RPE and outer retinal layers, absence of choriocapillaris, and adhesion between neuroepithelial layers and Bruch’s membrane. Usually located inferiorly.

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11
Q

RPE hyperplasia

A

RPE proliferates when there is CHRONIC LOW GRADE TRACTION. This may also occur in areas of inflammation or trauma

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12
Q

RPE hypertrophy

A

Happens with aging. Seen in periphery. Looks like CHRPE (bear tracks)

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13
Q

Peripheral cystoid degeneration

A

not a risk factor for RD. microcysts in far peripheral retina. HOLES MAY OCCUR HERE, but rarely cause RDs.

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14
Q

Retinal Break

A

Full thickness defect in neurosensory retina. Fluid may enbter breaks and cause RRD. Breaks are from holes (atrophy or inner retinal layers) or tears (traction)

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15
Q

Retinal break classifications

A
  • Flap or horseshoe tears
  • giant retinal tears
  • operculated holes
  • retinal dialysis
  • atrophic retinal holes
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16
Q

Giant retinal tear

A

extends more than 90 degrees, usually occurs at the posteior edge of the vitreous base

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17
Q

Operculated hole

A

traction is sufficient to tear retina completely off adjacent retinal surface

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18
Q

Retinal dialysis

A

circumferential linear break that occurs AT THE ORA with vitreous base attached to the retina’s posterior edge. Usually from blunt trauma

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19
Q

Atrophic hole

A

NOT associated with vitreoretinal traction and has not been linked to an increased risk of RD

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20
Q

Traumatic breaks

A

May cause retinal breaks by direct retinal perforation, contusion, or vitreous traction. Trauma tompresses the eye along AP axis and expands equatorial plane.

!!PVR may occur leading to traction and detachment

21
Q

Coup, contracoup

A

adjacent to trauma, opposite to point of trauma

22
Q

Most common type of break from trauma

A

Dialysis

23
Q

What happens when trauma occurs in a young eye

A 
Young vitreous has not undergone syneresis yet, so if a tear occurs, detachments may not develop for a while. 
12% occur immediately
30% in 1 month
50% in 8 mo
80% in 24 mo
24
Q

Prophylactically treat the following kinds of retinal breaks promptly

A
  • acute symptomatic dialysis

- acute symptomatic horseshoe tears

25
Q

No need for prophylaxis in these breaks

A

Asymptomatic/symptomatic atrophic round hole (usually found incidentally)
Asymptomatic operculated tear
Asymptomatic lattice w or without holes

26
Q

Consider prophylaxis in these breaks

A
  • Acute SYMPTOMATIC operculated holes
  • Asymptomatic dialysis
  • Lattice, atrophic holes, or asymptomatic tears where fellow eye had RD
27
Q

When should an asymptomatic retinal break be treated

A

Associated with:

  • lattice
  • myopia
  • RD
  • aphakia/pseudophakia
  • fellow RD
28
Q

When should lattice be treated

A

RD in fellow eye
Flap tears
Pseudo/aphakia

29
Q

Aphakia and pseudophakia in RDs

A

These eyes have higher risks of retinal detachment than do phakic eyes. Highest risk in first year (11 fold increase). Other risk factors include male, young, myopia, increased axial length, torn capsule, and absence of PVD

30
Q

Fellow eye RD

A

If one eye has an RD, the fellow eye has a 10 risk of detaching if phakic, and 20-36% risk of detaching if aphakic or pseudophakic. Prophylactic treatment of lattice and flap tears are recommended

31
Q

Subclinical retinal detachment

A

2 meanings:

  • Asymptomatic RD
  • SRF extends more than 1DD from the break but not more than 2DD posterior to the equator

30% of these detachments progress, so treatment is recommended. Demarcation line suggests lower risk, but progresison may occur through a demarcation line.

32
Q

Retinal detachment types

A

rhegmatogenous (most common). Break -> SRF ->detached

tractional: proliferative membranes contract and elevate retina

exudative (secondary) cased by retinal or choroidal disease in which fluid leaks beneath sensory retina and accumulates there

Differential dx include retinoschisis, choroidal tumors, and RD 2/2 choroidal dtchment

33
Q

Risk factors for RRD

A 
myopia
FH
fellow eye RD
Recent PVD
Trauma
peripheral lesions
vitreoretinal degenerations
?fluoroquinolones
34
Q

Signs of RRD

A

90-95% of patients have a break (Found with Lincoff’s rules)
50% have photopsias
IOP is lower in fellow eye (may be higher)
Shafer sign (tobacco dust)
Has convex bordres and appears CORRUGATED, undulates w eye movement
Fixed foled from a PVR almost always indicated RRD
Shifting fluid may occur, but more common in serous RDs

35
Q

Proliferative vitreoretinopathy

A

PVR most common cuase of failure following surgical repair of an RRD. in PVR, RPE, glial, and other cells grow, and migrate on inner and outer retinal surfaces and on vitreous, making membranes.

Contraction of these membranes causes fixed retinal folds, traction, and detachment

36
Q

PVR classifications

A

Grades A, B, and C correspond to increasing severity

Anterior (CA) and posterior (CP) are distinguished and subclassified into focal, diffuse, subretinal, circumferential, and anterior displacement.

37
Q

Lincoff’s rules

A

1: superotemporal or nasal detachments: 98% lie within the 1.5 clock hour of the highest border
2. Total or superior RDs that cross 12 o clock meridian: 93% it is at 12 o clock or in a triangle, where the apex is at the ora and the sides extend 1.5 clock hours to either side of 12 o clock
3. Inf RDs: 95% of the time, higher side of detachment indicates which side of the disc an inferior break lies
4. Inferior bullous RD: inferour bullae in an RRD comes from a superior RD

38
Q

3 principles for RRD repair

A

1 find the breaks
2 make a chordioretinal irritation (laser/cryo). Connect the RPE and the choroid to adhere to each other
3 close retinal breaks

39
Q

3 ways to bring retina and choroid together

A

scleral buckling
vitrectomy
pneumatic retinopexy

40
Q

TRD causes

A 
penetrating injuries
proliferative retinopathies (diabetes, sickle cell)
41
Q

Exudative RD

A

Caused by retinal blood vessel leak or RPE damage.

Characterized by shifting fluid and smoothness of detached retina (RRDs have corrugated appearance).

DDX: RRD with inferior bullous detachment, fixed retinal folds (which usually indicate PVR). Retina may be so elevated that it is visible behind the lens (Like in coats disease)

42
Q

Typical degenerative retinoschisis

A

precursor is typical peripheral cystoid degeneration (found at the ora). Cystoid cavities are in the OUTER PLEXIFORM LAYER

Appears pockmarked on scleral depression
May have white dots (foot plates of muller’s cells)
Peripheral cystoid degeneration may look bubbly anterior to schisis

43
Q

Reticular peripheral cystoid degeneration

A

located posterior to and continuous with typical peripheral cystoid degeneration but less common. Has linear or reticular pattern that corresponds to retinal vessels and a finely stippled internal surface. THIS IS IN NERVE FIBER LAYER (nfl)

may progress to RETICULAR DEGENERATIVE RETINOSCHISIS (BULLOUS RETINOSCHISIS)

44
Q

Which form of retinoschisis may lead to RD?

A

Reticular retinoschisis (clinical differentiation between typical and reticular may be difficult)

45
Q

Retinoschisis

A

-Bilateral in 50-80% of affected pts
occurs most frequently in the
-INFEROTEMPORAL ASPECT OF THE EYE
-occurs in hyperopes

46
Q

Schisis vs RRD

A

Schisis has an ABSOLUTE SCOTOMA. RRD has relative scotoma
Shafer sign and vit heme occur in RRD
Schisis has smooth surface and is dome, RRD is corrugated with an irregular surface

47
Q

Retinoschisis associated with full thickness retinal detachments

A
  1. Holes are in the outer but not inner wall of schisis and fluid can migrate through the hole in outer wall and detach retina. This kind of schisis does not progress, or it progresses slowly and RARELY NEEDS TREATMENT
  2. holes are in outer AND INNER layers. Schisis cavity may collapes and RRD happens. Breaks are usually posterior and may require buckling. Vitrectomy may be required
48
Q

Ocular pit maculopathy

A

small hypopigmented yellow round excavated colobomatous defects of optic nerve. Found on inferotemporo area of ON.

  • mostly unilateral, asymptomatic, and congenital. but can be acquired in setting of glaucoma
  • MAY LEAD TO SEROUS RDs.
  • RD will go from pit toward the fovea
  • OCT will show macular schisis and subretinal fluid (fluid is either CSF or vitreous)
  • DDX: glaucoma
49
Q

Macular hole in high myopia

A

RRDs can be caused by mac holes in highly myopic eyes with poserior staphylomas. These RRDS have a low success rate.

Retina (2 decks)

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