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Pathology > Retinal Pathology > Flashcards

Retinal Pathology Flashcards

1
Q

What is the most common cause of rhegmatogenous RD in childhood

A

Stickler’s syndrome (inherited)

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2
Q

What is retinoschisis and what can it lead to?

A

Acid mucopolysaccharide filled cavities split the neurosen- sory retina at the outer plexiform layer (typical retinoschisis) or the nerve fibre layer (reticular retinoschisis)

Can lead to rhegmatogenous retinal detachment

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3
Q

Where do retinoschisis occur?

A

Inferotemporal retina and bilateral

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4
Q

What is lattice degeneration?

A

Demarcated, circumferentially orientated areas of retinal thinning

Adjacent to the vertical meridian peripherally.

Atrophic small and round retinal holes can be present.

There is an associated risk of retinal detachment.

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5
Q

What histological abnormalities are seen in diabetic retinopathy?

A

Pericyte loss
Multilayering of the basement membrane
Degeneration of endothelial cells

Results in capillary non-perfusion and tissue ischaemia

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6
Q

What are signs of diabetic retinoapthy?

A

Micro-infarction (cotton wool spots)
Hard exudates
Microaneurysms
Haemorrhage
Neovascularisation

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7
Q

What are cotton wool spots? What layer of the retina?

A

Swollen ends of interrupted axons

NFL

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8
Q

What are hard exudates? What layer?

A

Reduced perfusion of the vascular bed and damage to the endothelium of the deep capillaries causing plasma leakage into the outer plexiform layer

Yellow well circumscribed area

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9
Q

What are hard exudates seen as histologically?

A

Foamy macrophaes with lipidW

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10
Q

hat are microaneurysms?

A

Ischaemia of the capillary bed - weakening of the wall by necrosis of the pericyte

  • bulging of vessel wall
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11
Q

What are flame haemorrhages layer?

A

Rupture of small arteriole leading to leak in the NFL (superficial)

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12
Q

What are dot haemorrhages? Layer?

A

Rupture of capillaries in the outer plexiform layer

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13
Q

What are blot haemorrhages

A

Larger than dot haemorrhages
Bleeding from capillaries with tracking between photorecptors and RPE

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14
Q

What is the order of haemorrhages in terms of layers?

A

Superficial - NFL - flame
Between photoreceptors and RPE - blot
Outer plexiform - deep - dot

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15
Q

What are intraretinal microvascular abnormalities

A

New vessel growing from venous side of capillary bed within an area of arteriolar non-perfusion.

Can leak on FFA and progress to vasoproliferative retinopathy

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16
Q

Which side of the capillary bed do new vessels grow?

A

Venous side

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17
Q

What is vasoproliferative retinopathy?

A

Ischaemic areas of retina release VEGF
Diffuse into retina and vitreous
Stimualte endothelial cell proliferation at the edge of the ischaemic area

New vessels form in prevenular capillaries and venules and proliferate whtin and on surface of retina

Diffusion of vasoformative factors to the iris surface and trabecular meshwork can lead to ruebosis iridis

18
Q

What happens in retinoapthy of prematuriy?

A

Blood vessels grow from disc towards periphery in utero driven by relative hypoxia

Prem infant on supplemental O2 - reduced hypoxic drive - extension of vascular bed inhibited

Infant returns to normal oxygen levels - excessive proliferation

Ischaemic peripheral non-vascularised retina
- further driving neovascularisation from peripheral vessels - grow rapidly and disorganised

Can lead to bilateral RD

19
Q

What occurs in hypertensive retinopathy

A

Hylinization of blood vessels leads to the appearance of copper or silver wiring

Narrowing of the vessels with spasm produces ischaemic effect on endothelial cells

Endothelium swells and degenerates

Leakage of fibrin into the vessel wall occurs

Further narrowing of lumen

Fibrinoid necrosis of choroidal and retinal vessels

20
Q

What is Eschnig’s spots

A

In hypertensive retinoapthy if the choriocapillaris is involved, lobular infarcts form Eschnig’s spots

21
Q

What causes CRAO

A

USually embolus from atheromatous plaque of carotid artery

22
Q

Why is the macula spared in retinal pallor?

A

Thinness of fovea and lack of neuronal tissue allowing a view of the choriocapillairs creating cherry red spot

23
Q

Where is the central retinal vein narrowed/

A

In the lamina cribrosa fo the optic disc

  • increased resistance provided by venous narrowing increases flow leading to turbulence and increased risk of thormbosis
24
Q

When are patients more likley to develop neovascularisation and rubeotic glaucoma

A

CRVO

Unlikely in CRAO

25
Q

When does age related degneration of the vitreous occur?

A

Teenage yearsW

26
Q

What is vitreous syneresis

A

Liquefaction of the collagen gel

27
Q

What is a neural reitnal detachment?

A

Separation between the neural retina and the RPE

28
Q

What are causes of retinal detachment?

A

Accumulation of fluid beneath neural retina
Traction bands in the vitreous such as in DR
Accumulation of fluid beneath a broken neural retina with vitreous traction - RRD

29
Q

What occurs in Best’s disease? Inhertiance? HIstology?

A

Autosomal dominant macula degneration

Accumulation of lipofuscin in RPE cells

Atrophy of photoreceptor layer

Disc of yellow tissue at macula

30
Q

What is STargardt’s disease? Inhertiance

A

Autosomal recessive macular dystrophy

Abnormal transport of metabolites across disc membrane of photoreceptors

Accumulation of lipofuscin in rod and cone disc spaces

destruction of RPE and photoreceptors

31
Q

What is the photoreceptor ene?

A

ABCA4

32
Q

What is seen in stargadt’s disease?

A

Atrophy of macula with small yellow flecks

Outer layer of retina is lost and with pigment epithleium is absent causing fusion of gliotic retina with BRuch’s

33
Q

What are risk factors for macular degneration

A

Smoking
Female
HTN
High fat and cholesterol intake
Blue iris
Abnormal skin sun sensitivity

34
Q

Features of Dry AMD

A

Pigmeent disturbances due to clumps of pigmented cells at the RPE level

Drusen

Geographic atrophy

35
Q

What are drusen? Layer?

A

Thickening of inner aspect of Bruch’s membrane

Hard drusen - small, well defined, do not predispose advanced ARMD

Softdrusen - large, ill defined borders - increase in size and number, risk of advanced ARMD

36
Q

What is geographic atrophy?

A

Late stages of dry ARMD representing atrophy of RPE

37
Q

What is seen on histology in ARMD??

A

Atrophy of photoreceptors

Well defied eosinophilic mounds beneath the RPE in hard drusen - macrophages and endothelial cells proliferate

Linear granular bands in diffuse drusen

BEtween cell basement membrane and Bruch’s membrae

38
Q

What deposit is liked to wet ARMD

A

Basal linear deposit between RPE cell membrane and its basement membrane

39
Q

What happens to the RPE in wet ARMD?

A

Fibrous metaplasia
Deposition of collagen
Disciform shaped mass beneath the macular - disciform degeneration

40
Q

What are symptoms of retinitis pigmentosa?

A

Night blindness

Progressive reduction in visual field from periphery towards posteiror pole

Tunnel vision

41
Q

What is seen on exam of retinitis pigemntosa

A

Retinal atrophy
Narrowing and opacifciation of reitnal vessels
Mixed coarse strands of pigmentation

42
Q

What is seen on histology in retinitis pigmentosa?

A

Outer nuclear layer at foves appears as single layer of cells with stunted photoreceptors

Outer nulcear layer is replaced by Muller cells which fuse with the RPE

RPE cells proliferate and migrate into the retina to become distributed around hyalinized vessels

Pathology (15 decks)

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