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Retina and Vitreous > Retinal Detachment, Vitreous Disease, and Posterior Segment Manifestations of Trauma > Flashcards

Retinal Detachment, Vitreous Disease, and Posterior Segment Manifestations of Trauma Flashcards

1
Q

Which of the following has/have no increased risk for RD:
flap tear, giant tear, operculated hole, retinal dialysis, atrophic retinal hole, lattice, systic retinal tufts, zonular traction retinal tufts, paving stone degeneration, typical cystoid degeneration

A

atrophic retinal hole, paving stone, typical cystoid degeneration

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2
Q

direction of traction in flap tear? appearance of flap?

A

traction pulls anteriorly, with the base of the flap at the anterior margin (the horse walks toward the cup)

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3
Q

criteria for giant retinal tear?

A

at least 3 clock hours (90 degrees) of continuous circumferential tear

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4
Q

most common cause of retinal dialysis?

A

blunt trauma

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5
Q

pathognomonic finding of ocular contusion

A

avulsion of the vitreous base

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6
Q

most common injury from ocular contusion

A

retinal dialysis

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7
Q

location of vitreous base

A

attaches 2 mm anterior and 4 mm posterior to ora

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8
Q

3 strongest sites of attachment of vitreous?

A

base is strongest, then optic nerve, then macula. also strong at margins of lattice, along vessels, and at chorioretinal scars

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9
Q

percentage of all acute symptomatic PVDs with a break?
in presence of vit heme?
w/o vit heme?
asympotomatic retinal breaks?

A

7-18%
50-70%
7-12%
5%

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10
Q

histology of lattice

A

inner retinal atrophy +/- atrophic holes with overlying vitreous condensation and firmly attached vitreous at the margins

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11
Q

where do tears usually occur when associated with lattice?

A

at posterior or lateral margin

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12
Q

three types of vitreoretinal tufts

A

noncystic, cystic, and zonular traction

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13
Q

name for folds of redundant retina? where are they most common?

A

meridional folds; most commonly superonasal retina, usually as an extension of a dentate process

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14
Q

oval island of pars plana epithelium surrounded by retinal tissue?

A

enclosed ora bay

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15
Q

histology of paving stones? most common location?

A

RPE and outer retinal atrophy with adhesion of inner retina to Bruch’s membrane. inferior retina, anterior to equator

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16
Q

rank by relative risk of RD: atrophic retinal hole, flap tear, acute operculate hole

A

flap tear > acute operculate hole > atrophic retinal hole

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17
Q

Treatment guidelines for symptomatic and asymptomatic flap tears, lattice, operculate holes, and atrophic retinal holes

A
  • Symptomatic flap tears almost always treated
  • Asymptomatic tears and lattice do not need to be treated unless they occur together or if other risk factors are present such as myopia, previous RD in fellow eye, or aphakia
  • Operculated holes generally are not treated unless there is residual vitreoretinal traction and they are symptomatic
  • Atrophic holes are rarely symptomatic and are rarely treated
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18
Q

Risk factors for RD post cataract surgery

A

male sex, younger age, myopia, increased axial length, posterior capsule tear

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19
Q

relative risk of RD 1 year post-phaco compared to general population? cumulative 20 year risk of RD post-phaco?

A

11 x

1.79%

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20
Q

what is a subclinical RD and how is it managed? what feature indicates a lower risk of progression?

A

either asymptomatic RD or an RD with SRF extending more than 1 DD from the break but no more than 2 DD poserior to the equator. 30% chance of progression, hence they are treated. demarcation line represents lower risk for progression

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21
Q

most common type of RD

A

rhegmatogenous

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22
Q

clinical signs of chronicity of rhegmatogenous RD

A

demarcation line, intraretinal macrocysts, atrophic retina

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23
Q

IOP in eye with RRD

A

generally lower (although can be higher)

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24
Q

what type of RD generally leads to fixed folds from proliferative vitreoretinopathy?

A

RRD

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25
Q

most common cause of failure of RRD repair

A

PVR

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26
Q

classification of PVR

A

A: vitreous haze or pigment clumping
B: wrinkling of inner retina, rolled and irregular edges of break
C: (subdivide into anterior and posterior) full thickness folds

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27
Q

Describe the 4 Lincoff rules

A

Describes probable location of break depending on location and type of RD:

  1. ST or SN detachments: break lies w/in 1.5 clock hours of highest edge of detachment
  2. Total detachment or detachment crossing 12 o’clock: break will be w/in triangle w/ apex at 12 o’clock and extending 1.5 clock hours from 12 in both directions
  3. Inferior detachment: break at highest side of RD
  4. Inferior bullous RD: superior break (with a fluid tract draining fluid to inferior bullae)
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28
Q

which type of trauma are tractional RDs more often associated with?

A

penetrating

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29
Q

leading causes of large exudative RDs

A

neoplasia and inflammation

30
Q

shifting fluid is most often associated with which type of RD?

A

exudative

31
Q

prevalence of typical peripheral cystoid degeneration? what do the cysts contain?

A

almost all adults older than 20; mucopolysaccharide

32
Q

location of reticular peripheral cystoid degeneration? what may this develop into?

A

almost always located posterior to typical peripheral cystoid degeneration; may develop into retinoschsis; nerve fiber layer

33
Q

histologic location of schisis in typical and reticular peripheral cystoid degeneration? which type is associated with complications, and what are those complications

A

typical: OPL
reticular: NFL. posterior extension, hole formation, and RD more common in this form

34
Q

Contrast retinoschisis and RRD based on the following:

  1. surface appearance
  2. vit heme or pigment
  3. scotoma
A
  1. smooth and dome-shaped in schisis, corrugated in RRD
  2. present in RRD, not schisis
  3. absolute scotoma in schsis, relative scotoma in RRD
35
Q

Describe the two types of RD that can develop from schisis, and how are they managed?

A

Type I: Hole in outer schisis but not inner allows fluid to migrate through hole to subretinal space and cause detachment. Demarcation lines are common. These generally do not progress and rarely require treatment

Type II: Hole in both inner and outer aspects of schisis, collapsing schisis cavity and acting like RRD. Treatment is generally required.

36
Q

most common quadrant for retinoschisis

A

inferotemporal

37
Q

excavated lesion at the optic nerve margin that protrudes posteriorly and is lined by retinal tissue: diagnosis, presentation, and important sequelae

A

optic pit; usually unilateral and asymptomatic; may lead to serous macular detachment or macular schisis

38
Q

risk factors for RRD from macular hole? relative prognosis?

A

posterior staphyloma and high myopia; far lower surgical success rate compared to either macular holes or RRDs

39
Q

name for the attachment of the vitreous to the optic disc

A

area of Martegiani

40
Q

synchesis v syneresis

A

synchesis is liquefaction and syneresis is collapse of vitreous gel

41
Q

what results in ERM formation?

A

proliferation of glia, RPE, or hyalocytes on anterior surface of ILM

42
Q

FA appearance of vitreomacular traction syndrome?

A

leakage at disc and central macula

43
Q

MOA and clinical use of ocriplasmin in vitreoretinal disease?

A

recombinant protease with activity agains fibronectin and laminin; can be injected intravitreously and cause resolution of VMT in ~27% of cases

44
Q

T or F regarding idiopathic macular holes:

  1. females with 2 x relative risk
  2. occur mostly in sixth through eighth decades
  3. bilateral in 50% of patients
A
  1. true
  2. true
  3. false; b/l in 10% of patients
45
Q

Stages of macular holes

A

0: VMA
1: impending hole; 50% resolve spontaneously
- -a: small yellow spot, inner foveal schisis
- -b: yellow ring, inner and outer foveal schisis
2: full thickness hole w/ VMT and 400 um, but vitreous still attached to disc
4: full thickness hole with complete PVD

46
Q

Management of macular holes

A
  • surgery indicated for stage 2 and above. PPV with gas -tamponade
  • ocriplasmin may be helpful for focal VMT causing full thickness hole (less useful for broad VMT)
47
Q

distinguishing anterior PFV from RB

anterior PFV v posterior PFV

A

PFV: leuokocoria present at birth, cataract common, no calcifications on ultrasound, microphthalmic eye, usually unilateral

lens is clear and anterior segment is normal in posterior PFV

48
Q

optically empty vitreous: 2 hereditary causes with inheritance and associated findings

A

Wagner: AD. myopia, strabismus, cataract. lattice but no risk of RD. no systemic findings

Stickler: AD. myopia, glaucoma, cataract. lattice with very high risk of RD. facial and skeletal abnormalities

49
Q

failure of peripheral retina to vascularize: diagnosis, inheritance, other findings

A

FEVR (familial exudative vitreoretinopathy). Mostly AD. Similar to ROP but in full term babies w/o respiratory problems. temporal dragging of macula may cause exotropia. high risk of RD of any type

50
Q

T or F regarding asteroid hyalosis:

  1. 75% unilateral
  2. crystals comprised of calcium-containing phospholipids
  3. usually visually insignificant
  4. associated with diabetes and hypertension
  5. often have abnormal vitreoretinal adhesions
A

all true

51
Q

vit heme + acute PVD:
% tears
% detachments

A

50-70% tears

8-12% detachments

52
Q

numerous refractile specks in inferior vitreous of patient with h/o trauma or surgery causing large vitreous heme? what are these composed of?

A

synchesis scinillans; cholesterol

53
Q

patient with polyneuropathy and eyelid and conjunctival nodules presents with progressive vision loss. vitreous is very hazy: diagnosis, and what other ocular disease do these patients often develop

A

familial amyloidosis; glaucoma

54
Q

location of choroidal ruptures? management?

A

often in periphery and/or concentric to disc; no acute management, although patients at risk for developing CNV

55
Q

sclopetaria

A

large area of choroidal and retinal rupture with extensive blood in all layers, associated with high speed projectile injury to orbit. lesions scar down extensively and have a low risk of RD

56
Q

common areas of globe rupture? most common quadrant?

A

limbus, under EOM insertoins, at surgical wounds

SN most common, then IT (countercoup, then coup)

57
Q

penetrating v perforating

A

penetrate only has entry wound, perforate has entry and exit wound (through-and-through)

58
Q

suture for corneal and for scleral wounds in traumatic globe repair

A

cornea: 10-0 nylon
slcera: 9 -0 nonabsorbable

59
Q

timing of vitrectomy after open globe

A

may wait 2-14 days to lead blood and inflammation settle, lead vitreous detach naturally, or let cornea clear. however, urgent vitrectomy needed if retained IOFB or evidence of endophthalmitis at time of repair

60
Q

indications for vitrectomy for perforating injury

A

damage to other intraocular tissues, transvitreal traction along wound, moderate to severe vit heme, phacoantigenic uveitis

61
Q

imaging study to eval IOFB?

A

MRI contraindicated if suspicion for metallic FB. CT is best for radiopaque materials (like metal)

62
Q

Which of the following can be left in the eye?

stone, sand, glass, porcelain, cilia, aluminum, zinc, iron, copper

A

stone, sand, glass, porcelain, cilia

63
Q

Which metallic IOFB is capable of causing severe acute inflammation that may lead to loss of the eye?

A

copper (esp pure copper)

64
Q

signs of chronic chalcosis

A

(copper) deposits in Descemet’s (similar to Kaiser-Fleischer ring), green discoloation of iris, sunflower cataract, vitreous and retinal opacities

65
Q

signs of ocular siderosis

A

(iron accumulation): accumulation and toxicity in any neuroepithelial tissue causing an array of issues. ERG may initially show increased a- wave, but eventually will diminish and may become undetectable

66
Q

what class of antibiotics should be AVOIDED in treatment of traumatic endophthalmitis?

A

aminoglycosides (narrow therapeutic window and high risk of retinal infarction)

67
Q

most common cause of post-traumatic endophthalmitis? treatment?

A

Bacillus cereus; sensitive to intravitreal vanc and or clinda

68
Q

ocular and extraocular findings in abusive head trauma (aka shaken baby syndrome)

A

ocular: retinal hemorrhages (especially with hemispheric contour), cotton wool spots, and hemorrhagic schisis cavities. (these RARELY occur in accidental trauma like falls or bumps to head)
extraocular: bradycardia, hypothermia, lethargy, seizures, failure to thrive, spiral fractures of long bones, bulging fontanelles

69
Q

Type of photic damage in:

  1. solar retinopathy
  2. phototoxicity from ophthalmic instrumentation
  3. arc welding
  4. laser photocoagulation
  5. Q-switched Nd:YAG laser
A
  1. photochemical
  2. photochemical
  3. photochemical
  4. thermal
  5. mechanical (this is YAG cap laser)
70
Q

risk factors and protective factors for solar retinopathy

A

RF: young age, clear media, concomitant photosensitizing drugs (tetracyclines, psoralens), light fundus

protective: uncorrected refractive error, dark fundus

71
Q

findings in solar retinopathy? treatment? prognosis?

A

bilateral yellow-white spot on fovea that turns red over time and then develops into a lamellar hole by 2 weeks. generally recover 20/20-20/40 vision. no treatment.

Retina and Vitreous (6 decks)

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