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Posterior Segment > Retinal Vasculature/ Anatomy/ Physiology > Flashcards

Retinal Vasculature/ Anatomy/ Physiology Flashcards

1
Q

What are the 10 retinal layers in order from internal to external?

A

Internal limiting membrane
Nerve Fiber layer
Ganglion Cell layer
Inner Plexiform layer
Inner nuclear layer
Outer Plexiform Layer
Outer Nuclear layer
External limiting membrane
Photoreceptor Layer
RPE
(Bruch’s membrane)
(choroid)

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2
Q

What artery supplies the inner two-thirds of the retina?

A

Central Retinal Artery

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3
Q

What vein drains the inner two-thirds of the retina?

A

Central retinal vein

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4
Q

What layer of the retina divides the inner and outer retina?

A

External limiting membrane

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5
Q

What supplies and drains the outer one third retina?

A

Choroidal-choriocapillaris system

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6
Q

Does the retina have high or low oxygen consumption?

A

High oxygen consumption. The highest of any tissue in the body.

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7
Q

What layer of artery creates the lumen and is a single layer of epithelium?

A

Intima

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8
Q

What layer of the artery separates the intima and media layers?

A

internal elastic lamina

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9
Q

Describe the elasticity of arteries?

A

Have very thin internal elastic lamina. Most abundant around the optic nerve but decreases elasticity in the periphery.

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10
Q

What layer of the blood vessel is the smooth muscle layer?

A

Media

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11
Q

What is the outer layer of the connective tissue?

A

Adventitia

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12
Q

What layer of the retina are the retinal arteries strongly attached to?

A

internal limiting membrane

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13
Q

Describe the musculature of arteries?

A

Contain smooth muscle all throughout the vascular wall

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14
Q

What general thing do retinal arteries respond to?

A

Biological markers (example, oxygen/CO2 levels), not sympathetic/parasympathetic nervous system

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15
Q

What layers of the retina are retinal arteries/ arterioles and veins/venules located in?

A

Nerve fiber layer
Ganglion cell layer

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16
Q

What forms the central retina artery?

A

Internal carotid –> Ophthalmic artery –> Central retinal artery

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17
Q

Describe the elasticity and musculature of retinal veins

A

Contain a lot of elastic tissue and small amounts of smooth muscle tissue(most at optic nerve).

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18
Q

If you see blood vessels that have tortuosity, what kind of blood vessel would this be?

A

A vein due to the high amounts of elastic tissue and almost no musculature.

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19
Q

Where do veins loosely attach to?

A

Loosely attached to Nerve fiber layer (glial perivascular limiting membrane of Kruckmann)

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20
Q

When arteries and veins cross, what blood vessel typically crosses over the top?

A

Artery crosses over top of the veins.

Can be seen in high cholesterol, with hardening of artery it can press on the vein and cause the blood to back up which causes vein occlusion

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21
Q

What is larger? The artery or vein? Normal ratio?

A

Vein is larger. 2/3rds AV ratio so the artery is 2/3rds the size of the vein.

22
Q

What blood vessel appears brighter? Arteries or veins?

A

Arteries

23
Q

Where is the inner(superficial) capillary network located?

A

Inner two-thirds of retina
Specifically, ganglion cell layer and nerve fiber layer

24
Q

Where is the outer(deep) capillary network located?

A

Inner two thirds of retina
Specifically, inner nuclear layer

25
Q

What are the 3 capillary avascular zones?

A

FAZ- foveal avascular zone
Ora
Near arteries/arterioles

26
Q

Describe composition of retinal capillaries

A

Do NOT contain smooth muscle or elastic tissue
DO contain endothelial cells that create tight blood-retinal barrier. Also contain Pericytes.

27
Q

What are the 3 capillary zones?

A

Circumpapillary zone (radial network)
Perifoveal zone
Ora zone

28
Q

Why is the circumpapillary zone highly vascularized with capillaries?

A

Near macula/fovea which needs a lot of oxygen

29
Q

Describe RPE (retinal pigmented epithelium) characteristics

A

-Heavily pigmented single layer of cells that are tightly bound to each other
-Extends from the optic nerve to the ora serrata
-Turns into the pigmented epithelium of the ciliary body
- Loosely attached to the photoreceptors

30
Q

What fills the space between RPE and photoreceptors?

A

mucopolysaccharide “glue”

31
Q

If a break in the RPE occurs, what can happen?

A

fluid can leak upward from the choriocapillary system

32
Q

What does the basement membrane of the RPE make a very tight bond with?

A

Bruch’s membrane. Must require a strong force in order to separate the two.

33
Q

What does the RPE get its nutrients from?

A

Choriocapillaries

34
Q

What serves as a barrier between the sensory retina and the choroid that metabolizes waste?

A

RPE

35
Q

What are some functions of the RPE?

A

Processes metabolites/ waste for the retina
Neutralizes short wavelength light energy
barrier between sensory retina and choroid

36
Q

What kind of imaging systems can take good images that let us evaluate the RPE?

A

FAF- fundus autoflouresence
MultiColor

37
Q

Describe Bruch’s membrane structure, layers/ characteristics

A

Extends from optic nerve to ora serrata

-Multilayered
-innermost layer is basement membrane of RPE
- thickest layer of Bruch’s membrane is inner collagenous zone and is covered by elastic layer
-elastic layer is middle layer
-outer collagenous layer is continuous with the choroidal zone and becomes the membrane of choriocapillaris

38
Q

As RPE thins, what happens to Bruch’s membrane ? What can this cause?

A

Bruch’s membrane thickens which can cause it to be more susceptible to damage which can present as drusen. Can lead to macular degeneration

39
Q

Are choriocapillaris fenestrated or not fenestrated? What does this mean?

A

Choriocapillaris is fenestrated which means blood can flow in and out

40
Q

What blood vessels feed into the choriocapillaris system?

A

Short posterior ciliary arteries
Posterior ciliary arteries
Anterior ciliary arteries

41
Q

What drains into the vortex vein ampulla?

A

Venules

42
Q

Where are vortex veins typically located?

A

At the equator

43
Q

Where is the greatest activity of the choriocapillaris?

A

Near the fovea

44
Q

If the choriocapillaries infarct (lack of blood), what can this result in?

A

Elschnig Spots - “window defect” (white spots due to atrophy of RPE and photoreceptors)

Siegrist streaks- pigmentary changes (due to blood pressure spike, typically in post pole)

Pavingstone Degeneration- “cobblestone degeneration” more in periphery near equator. (Likely congenital, blood pressure spikes, common)

45
Q

What is the choroid composed of?

A

Blood vessels
Nerves
Melanocytes
Immune system cells
Basement membrane of Bruch’s membrane

46
Q

What are the two layers of the choroid? What is the difference between the two layers?

A

Sattler’s layer - medium sized vessels
Haller’s layer - larger vessels

Difference is the size of the vessels in the layers.

47
Q

What is the deepest layer of vascular retina that is adjacent to the sclera?

A

Suprachoroidal lamina

48
Q

What kind of vessels are found in the suprachoroidal lamina?

A

Long and short posterior ciliary arteries

49
Q

True or false:
The choroid responds to sympathetic innervation unlike the inner retinal vasculature.

A

True

50
Q

What is the function of the choroid?

A

-Supply nutrients to RPE, photoreceptors, and outer one-third of the retina.

  • MAIN FUNCTION…. Removes heat generated by light absorption of the RPE and metabolic activity of the retina

-Responsible for growth factor secretion

51
Q

Why is venous pulsation or SVP (spontaneous venous pulsation) important?

A

As a doctor, you may be able to see the pulse by looking at the blood vessels. If you were able to see a pulse rate in a patient at one point and documented it, but 10 years later you are unable to see it, something has changed. Possibly vein occlusion, glaucoma surgery, etc.

52
Q

What are the 3 types of blood vessel pulsations? Which is abnormal?

A

1) Venous pulsation - SVP
2) Arterial Pressure (abnormal) - increased IOP
3) Serpentine Pulsation - in young children, bilateral, superior arcades

Posterior Segment (6 decks)

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