Retinal disease Flashcards
Epiretinal membrane
- Definition
- Cause/ associations
- Symptoms
Occurs when a layer of fibrocellular tissue forms on the inner surface of the retina.
Associations
- Posterior vitreous detachment
- Idiopathic
- Secondary to other disease: diabetic retinopathy, retinal vein occlusion, retinal tear/ detachement.
Symptoms
- Metamorphopsia (distorted vision)
- Blurred vision
- Monocular diplopia
- Micropsia (objects appear smaller than normal)
Epithelial membrane
- Diagnosis
- Management
Fundoscopy
- Wrinkling of retinal surface
- Blunting of fovea contour
OCT
- Thickening of retina
Management
- Vitrectomy
- Membrane peel
Age-related macular degeneration
- Definition
- Classifications
Degradation of the retinal pigmented layer due to age associated mechanisms.
Classifications
- Dry (most common)= drusen deposits, geographical atrophy.
- Wet= intraretinal oedema, choroidal neovascularisation, retinal pigment epithelial detachement.
AMD
- Presentation
- Investigations
Presentation
- Sudden onset, decreased/loss of central vision
- Poor night vision
- Metamorphopsia
Investigations
- Amsler grid: visual distortion
- Snellen chart: loss of central acuity
- OCT= choroidal neovascularisation, intra/subretinal fluid, pigment epithelial detachement, scarring
- OCT angiography= choroidal neovascularisation
AMD
- Management
Risk factor modification
- Smoking cessation
- BP control
- Reduction of LDLs in diet
Wet AMD
- Anti-VEGF injections for neovascularisation
- Thermal laser photocoagulation
AMD
- Management
Risk factor modification
- Smoking cessation
- BP control
- Reduction of LDLs in diet
Wet AMD
- Anti-VEGF injections for neovascularisation
- Thermal laser photocoagulation
Characteristic features in the fundus appearance of retinitis pigmentosa
Optic disc
- Temporal pallor
Blood vessels
- Retinal vessel attenuation
Retina
- Bone-spicule hyperpigementation
Clinical features of retinitis pigmentosa
Loss of night vision (nyctalopia)
Loss of peripheral vision
Genetics of retina hyperpigmentosa
Can be inherited in 3 forms
- Autosomal dominant/ recessive
- X-linked
Autosomal dominant retinitis pigmentosa is most commonly caused by mutations in what gene?
RHO
- rhodopsin gene, responsible for translating light into phototransduction signals
Risk factors for the progression of diabetic retinopathy
Lack of exercise
Poor glycaemic control
Poor BP control
Pregnancy
Infrequent eye check up
Risk factors for the progression of diabetic retinopathy
Lack of exercise
Poor glycaemic control
Poor BP control
Pregnancy
Infrequent eye check up
Indication for intravitreal anti-VEGFs injections
Macular oedema
Fundoscopy findings of branch retinal vein occlusion
Most commonly affects the superotemporal region
Cotton wool spots
- Ischaemic regions located in the region drained by affected branch
Superficial haemorrhages (flame haemorrhages)
Retinal oedema
Fundoscopy findings of a branch retinal artery occlusion
Yellow/ Pale spot in a branch of the central retinal artery
Central retinal vein occlusion
- Presentation
Sudden, complete painless loss of vision
Central retinal vein occlusion
- Fundoscopy findings
Superficial retinal haemorrhages (flame haemorrhages) in all 4 quadrants
Macular oedema
Optic disc oedema
Neovascularisation
Central retinal vein occlusion
- Risk factors
Vasculopathic risk factors:
- Hypertension
- High cholesterol
- Diabetes
- Smoking
- Glaucoma
- Systemic inflammatory conditions
Central retinal artery occlusion
- Risk factors
- Giant cell arteritis
- Older age
- Family history
- CAD risk factors: Smoking, Hypertension, Diabetes, Poor diet
Central retinal artery occlusion
- Presentation
Sudden, painless complete loss of vision
Relative afferent pupillary defect (RAPD)
Central retinal artery occlusion
- Fundoscope findings
Cherry red spot
- Thin macula showing the underlying choroid
Pale retina
- Lack of perfusion
Immediate management of central retinal artery occlusion (within 3 hours)
- Ocular massage
- Removing fluid from the anterior chamber to reduce intraocular pressure.
Dilation of artery
- Inhaling carbogen (a mixture of 5% carbon dioxide and 95% oxygen) to dilate the artery
- Sublingual isosorbide dinitrate
Management of central retinal artery occlusion
Aspirin 300mg
Stroke clinic
ABCD2 score
- Risk of stroke following TIA
Management of central retinal vein occlusion
Uncomplicated
- Reducing risk factors
Macular oedema
- Anti-VEGF injections
Neovascularisation
- Pan-retinal photocoagulation
Drugs that cause cystoid macular oedema (4)
Lantanosprost
Epinephrine
Rosiglitazone
Nicotinic acid
Drugs that cause bull’s eye maculopathy (2)
Hydroxychloroquine
Chloroquine
Tamoxifen can lead to what adverse effect on the retina
Crystalline maculopathy
Medicat
