Retinal Disease Flashcards
AMD features
> 50yo (commonest LOV >50yo - 48%)
bilateral (Can start unilateral)
central blind spot, distortion, gradual/progressive
LOV >50yo: 48% AMD 28% other 11% glaucoma; 5% cataracts 2% RP; 2% DR; 2% myopia
AMD RF
age
smoking
CVD: HTN, lipids
low antioxidants
AMD - dry/atrophic
90% of AMD, 10-20% of severe AMD; can convert to wet
RPE + inner choroid atrophy, receptor death
macula: slow gradual central loss
Drusen: focal Bruch membrane thickening; separates RPE; blocks blood supply to receptors
No Rx; monitor for conversion
AMD -wet/neovascular
10-20% AMD, 80-90% severe AMD (visual loss)
visual distortion (Amsler grid), sudden central loss (refer!!)
choroidal neovascularisation (CNV)
occult: beneath Bruch’s
classical: through BM into subretinal space
fragile vessels bleed/leak; causes fibrous scarring
can penetrate into retinal layers
AMD - impact
falls risk
ADLs: shopping, money, meals, phones, housework
emotional distress, depression, self-esteem
healthcare/support use
reading, time-telling, face recognition, driving
loss of independence, productivity
AMD - evaluation/Ix
VA (near/far)
central visual field (Amsler)
reading speed
contrast sensitivity
fundus photos
angiography: fluoroscein and indocyanine green
optical coherent tomography (OCT
USS
AMD - CNV classification
extrafoveal: >200u
juxtafoveal: 1-199u
subfoveal: under centre
classic leakage: bright, defined angiogram
occult leakage: granular angiogram
mixed leakage
AMD - treatment (wet)
anti-VEGF: macugen, Lucentis, Ranibixumab, aflibercept
laser photocoagulation: defined extra/juxta classical; 50% recur
anti-VEGF (antiangio, antipermeability): first line; 70% success; 6-weekly
intravitreal steroids adjunct
triamcinolone (steroid): anti-perm, anti-inflam
RTX
PDT: visudyne; 3-monthly;
surgery (salvage): vitrectomy, submacular excision, macula rotation
DR - background
2% UK population
commonest working age visual impairment/blindness
mostly preventable
DM = 25x risk of blindness
incidence correlates duration
DR - RF
duration: 5% presentation, 50% 10y, 90% 30y
TI > TII but longer delay/onset
age, smoking, HTN, hyperlipidaemia, obesity
poor control
pregnancy, renal impairment
DR - pathogenesis
microangiopathy
microvascular occlusion (3): capillary: loss of pericytes, thick BM, damaged endo (proliferates) deformed RBC platelet aggregation *ischaemia/hypoxia: IRMA and VEGF/NV
leakage (3):
tight junction breakdown: plasma leakage
local capillary distension: microaneurysms
increased permeability: intraretinal hge and oedema
DR - features
heamorrhage, microaneurysms: dot/blot (Deeper)
CWS: pre-capp occlusions + axoplasm leak; NFL
IRMA: AV shunts (not over other BV)
venous beading/looping: capp closure
DR - NPR features
usually aSx; 8-10y duration
microaneurysms: temporal, INL
exudate: defined yellow/white spots; lipoprotein leakage
CWS: grey/white fluffy NFL; axoplasm by infarcts
hge: dot or blod; venous capps; deep retina
DR - NPDR classification
(Arlie House: mild/mod/severe/very severe)
NSC: RO (none), R1 (bg), R2 (pre-prolif), R3 (proliferatives; a/s)
M0/M1 (maculopathy)
background: ma (INL), hard exudates (OPL), intraretinal hge
pre-proliferative: CWS, IRMA, dark blot hge, looping/beading
mild: ma only
mod: hge in 1+ quadrants; CWS/beading/IRMA
severe (4-2-1): hge in 4; beading in 2; IRMA in 1
very severe: 2 severe criteria
DR - PDR features
5% of DM; TI > TII
NVD or NVE: small tufts, ramifying from vv
extend into vitreous: pre-retinal/VHge risk
fibrosis: tractional RD risk
rubeosis iridis and neovascular glaucoma
