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Posterior Seg > Retinal Vascular Anatomy and Physiology > Flashcards

Retinal Vascular Anatomy and Physiology Flashcards

1
Q

Central retinal artery system, including the retinal capillary system supplies which portion of the retina?

A

The inner two thirds of the retina

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2
Q

____ divides the inner and outer retina

A

External limiting membrane

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3
Q

Choroidal choriocapillaris system supplies and drains which portion of the retina?

A

The outer 1/3

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4
Q

The hyaloid vascular system supplies the developing eye for how many months during gestation?

A

4 months

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5
Q

____ develop vascular channels that grow into the nerve fiber layer

A

Bergmeister’s papilla

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6
Q

Development of vasculature continues for how many months after full gestation?
What about capillaries?

A

3

Capillaries continue to develop for several years.

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7
Q

Which artery enters the optic nerve and supplies blood to the inner 2/3 of the retina?

A

Central retinal artery. Susceptible to occlusion as it enters with ON thru lamina cribrosa.

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8
Q

Artery vessel layer from inner to outer

A

Inner

Intima - single layer of epithelium that blood contents are in contact with.

Internal elastic lamina - Separates intimate from media. Less of this in arteries. Discontinuous and minimal. More in veins.

Media = Muscle. Lots in arteries!

Adventitia outermost layer of CT. Forms strong bond with artery and internal limiting membrane!

Outer

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9
Q

Arteries stop ___mm before ora

A

1.5mm

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10
Q

Why do arteries have a strong attachment to the retina?

A

The outer layer of the artery, the adventitia, forms a strong bond with the ILM.

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11
Q

What layer of an artery is discontinuous or minimal? What layer is abundant?

A

Minimal- Elastic lamina.

Adbundant smooth muscle in vascular wall.

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12
Q

Arteries and arterioles have auto regulation. What does this mean?

A

Arteries in the retina do not respond to sympathetic or parasympathetic system. They respond to O2, Co2, and growth factors.

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13
Q

Where are retinal arteries and arterioles located?

A

NFL or ganglion cell layer.

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14
Q

How does the internal carotid enter the eye thru the ON?

A

Internal carotid –> ophthalmic artery –> central retinal artery enters thru ON

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15
Q

Veins expand in diameter as they merge to develop the ___

A

Central retinal vein. This tapers at the lamina cribrosa. May cause turbulent blood flow.

Also stops 1.5mm before Ora.

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16
Q

artery and vein attachment

A

Glial perivascular limiting membrane of kruckman. Provides insulation and CT/

Both located in NFL or ganglion cell layer.

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17
Q

Which crosses over which? arteries vs veins

A

Arteries usually cross over veins. This may cause vein occlusion or narrowing.

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18
Q

Which are larger? Arteries or veins

A

Veins larger than arteries.

Arteries are 2/3 the size of veins.

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19
Q

Brightness of arteries vs veins

A

Arteries are brighter, but smaller.

Veins are duller, but larger.

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20
Q

Difference between the layers of arteries and veins

A

Arteries- lots of smooth muscle, minimal elastic tissue. Rigid.

Veins- Lots of elastic tissue, minimal smooth muscle. Elastic.
**But contains smooth muscle as it travels thru ON.

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21
Q

Artery and vein location

A

Both located in NFL or ganglion cell layer.

22
Q

Retinal capillaries supply which portion of the retina?

A

Supply the inner 2/3 of the retina.

23
Q

There are two capillaries that supply the inner 2/3 of retina. Where are they located and what are they called?

A

Inner/superficial capillary network.
-Ganglion cell layer or NFL.

Outer/deep capillary network.
-Inner nuclear layer.

24
Q

The inner/superficial capillary network is usually affected by what diseases

A

Artery based diseases. HTN

25
Q

The outer/deep capillary network is usually affected by what diseases?

A

Venous based diseases- DM.

26
Q

Where are the 3 capillary free zones?

A
  1. Foveal avascular zone.
  2. Ora serrata.
  3. Around arteries/arterioles
27
Q

Structure of retinal capillaries?

A

Endothelial cells form the inner blood-retinal barrier. Tight junctions. Completely closed system. Never want blood leaking into inner 2/3 of retina.

Do not contain smooth muscle or elastic tissue.

pericytes are responsible for auto regulation of the microvascular circulation.

28
Q

3 main capillary zones

A
  1. Circumpapillary zone or radial network.
    - Series/network of capillaries that tend to be thicker or multiple capillary zones/layers.
    - Located around ON and 1-2 DD superior temporal and inferior temporal.
29
Q

Perifoveal zone

A

Inner and outer networks merging. approach the avascular zone.

30
Q

Ora zone

A

Appraoches avascular zone. Networks merge into single layer.

31
Q

Layers of the retina superficial to deep

A 
ILM 
NFL
Ganglion cell layer 
IPL
INL
OPL
ONL
ELM
IS- inner seg of PR
OS- outer seg of PR
RPE Retinal pigmented epithelium - supports PR
Bruch's membrane 
Choroid -Choriocapillaris, Satlers, Haller's, suprachoroidal lamina
Sclera
32
Q

Layers of Bruch’s membrane from outer to inner

A 
Basement membrane of endothelial cells of the choriocapillaris 
Outer collagen layer 
Elastin layer 
Inner collagen layer 
Basement membrane of RPE

*****Basement membrane of RPE and bruchs membrane form a very tight bond. Unlikely for this to break.

33
Q

RPE extends from where to where? then becomes

A

ON to Ora (Same with Bruch’s)

Then becomes pigmented epithelium of ciliary body

34
Q

How are RPE and photoreceptors connected?

A

Space between is filled with mucopolysaccharide glue. They are loosely bound to each other, which can lead to detachments of the PR form the RPE.

RPE Is tightly bound to each other- if this breaks, then the choriocapillaris would leak through.

35
Q

What is the function of the RPE?

A

Serves as a barrier between the sensory retina and choroid.

Processes metabolites/waste for the retina.

Absorbs UV light

36
Q

Structure of Bruch’s membrane Inner to outer. What is the thickest layer?

A 
Inner
RPE basement membrane 
Inner collagen- thickest layer 
Elastic layer- middle 
Outer collagen 
Choriocapillaris basement membrane
37
Q

What is the function of Bruch’s membrane

A

Acts as a barrier between the RPE and choroid.

Can break down with age and allow fluid to leak through.

38
Q

What feeds into the choriocapillaris system?

A

Short posterior ciliary arteries
Branches of the long posterior ciliary arteries
Branches of the anterior ciliary arteries

39
Q

Venules drain the choriocapillaris system in to the

A

Vortex vein ampulla.

40
Q

Where is the greatest activity of the choriocapillaris?

A

Fovea.

41
Q

Choriocapillaris function

A

Capillary bed of the choroidal system.

42
Q

What happens if there is an infarct of the choriocapillaris?

A
  1. Elschnig spot/Window defect. Congenital. Loss of RPE and overlying photoreceptors. Appears as white spot located in the posterior pole.
  2. Siegrist streaks. Poorly controlled HTN. Located in posterior pole.
  3. Pavingstone degeneration. Congenital. Located in the periphery. Pt’s are usually unaware.
43
Q

Elschnig spot/window defect

  • What is it
  • How does it occur
  • Appears as?
  • location?
A

Congenital defect due to choriocap infarct.
Causes loss of RPE and overlying PR cells.
Appears as white spot
Posterior pole

44
Q

Siegrist streaks.

  • What is it
  • Why does it occur
  • Location
A

Infarct in choriocap due to poorly controlled HTN.

Located in Posterior pole.

45
Q

Pavingstone degeneration

  • What is it
  • how does it occur
  • location
A

It is due to choriocap infarct
Congenital
Located in peripheral.
Pts usually unaware.

46
Q

Difference between choriocapillaris capillary system and the inner 2/3 retina capillary system

A

Choriocapillaris- OPEN SYSTEM. Responds to sympathetic innervation AND auto regulation.

Inner 2/3 capillary networks- Tightly contain blood. No leakage. Only responds to auto regulation, not sympathetic innervation.

47
Q

Suprachoroidal lamina

A

BM of choroid. Contains long and short posterior ciliary arteries.

48
Q

Function of choroid

A

Responds to sympathetic innervation and auto regulation.

Supplies nutrition to the RPE, PR, and outer 1/3 of the retina.

Removes heat that is generated by light absorption of the RPE and metabolic activity of the retina.

49
Q

___ absorbs UV light.

___ removes the heat

A

RPE absorbs.

Choroid removes

50
Q

Venous pulsation/SVP is due to

A

Ventricular rate (heart rate)

Have it and then it goes away? Some etiology must have occurred due to localized pressure on ONH.

51
Q

Arterial pulsation

A

NOT NORMAL

Eye pressure > artery pressure or lack of blood flow in carotid arteries.

52
Q

Serpentine pulsation

A

Seen in young patients
Idiopathic
In arteries

Posterior Seg (4 decks)

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