Unit 6 - VMT, CMO, ret dystrophies

Question 1

What are the 5 symptoms of VM disorders?

Answer 1

1. Gradual loss of V/A
2. Difficulty with binocular s/v
3. Distortion
4. Central scotoma
5. Monocular diplopia

Question 2

What is the general management of VM disorders?

Answer 2

1. Patient counselling/reassurance
2. Vitrectomy with macula peel if sig symptoms
3. Combined vity with mac peel and phaco

Question 3

What ocular investigations should be conducted on VM disorders?

Answer 3

1. Amsler
2. OCT
3. Photography (red-free will show sudden changes in vessel direction)
4. FFA to exclude other causes

Question 4

What is NICE guidance on the use of Jetrea in VM disorders?

Answer 4

Can be used if macula hole is <=400microns or there are severe symptoms and if ERM not present

Question 5

What are the cons of Jetrea?

Answer 5

Has shown to loosen zonules in mice.

Question 6

How are macula holes classified by size?

Answer 6

By size horizontal measurement along narrowest point:

• Small <250 mics (95% surgical success)
• Medium (250-400) 85-90% surgical success
• Large (>400microns) 25-50% success

Question 7

How are macula holes classified by cause?

Answer 7

Primary initiated by VMT Secondary due to disease or trauma

Question 8

How are pseudo-holes different?

Answer 8

1. Invaginated foveal edges
2. Associated ERM
3. No loss in retinal tissue

Question 9

What is an ERM?

Answer 9

Fibrocellular proliferation contracting as a sheet over the surface of the ILM

Question 10

How often are ERM’s bilateral?

Answer 10

10-35% of the time

Question 11

What are the 5 ocular risks of developing an ERM?

Answer 11

1. RD
2. RVO
3. DR
4. Trauma
5. Uveitis

Question 12

What are the clinical signs of an ERM?

Answer 12

1. Wrinkling of superficial light reflexes
2. White, thick membrane structure visible
3. Translucent membrane with distortion and angulation of retinal blood vessels

Question 13

How many cases of VMT spontaneously resolve?

Answer 13

15-50%

Question 14

What does jetrea target

Answer 14

Fibronectin laminin and collagen

Question 15

How long after resolution do VMT symptoms continue after resolution?

Answer 15

6-9 months

Question 16

How often does CMO occur after ICCE?

Answer 16

5-15%

Question 17

What is the proposed pathogenesis of CMO?

Answer 17

Cytokines released by inflammatory cells break down blood-retinal barrier causing capillary leakage

Question 18

What other proposed causes of CMO are there?

Answer 18

1. VMT
2. Vitreous inflammation
3. Disc swelling
4. Prostaglandin release in vitreous
5. Lens removal

Question 19

What factors put you at risk of CMO?

Answer 19

1. Diabetes
2. Capsular rupture
3. ERM
4. Previous uveitis, RVO or RD

Question 20

What are the clinical signs of CMO?

Answer 20

1. Macula thickening
2. Loss of foveal depression
3. 3-4 large central cysts
4. Vitreous cells
5. Central yellow spot

Question 21

What FFA appearance will you see in CMO?

Answer 21

FFA will show leakage from perifoveal caps

Late leakage into fovea with a petalloid appearance

Mild optic disc leakage

Question 22

What is the differential diagnosis of CMO?

Answer 22

1. Diabetic maculopathy
2. BRVO
3. Exudative ARMD
4. Radiation retinopathy

Question 23

When should treatment be considered for CMO?

Answer 23

if Reduced v/a and clinical macula oedema

Question 24

What are the treatments for CMO?

Answer 24

1) Topical NSAID’s e.g Ketorala (acular) for 6/52
2) Acetazolamide twice daily for 6/52
3) Intravitreal triamincinolone, can be given intraoperatively in susceptible patients or post-surgery as a sub-tenons injection
4) Vitrectomy

Question 25

Why does acetazolamide work in CMO?

Answer 25

It increases the action or the RPE pump

Question 26

What are the long terms complications of CMO?

Answer 26

Multiple remissions can result in photoreceptor death.