Unit 6 - VMT, CMO, ret dystrophies Flashcards
What are the 5 symptoms of VM disorders?
- Gradual loss of V/A
- Difficulty with binocular s/v
- Distortion
- Central scotoma
- Monocular diplopia
What is the general management of VM disorders?
- Patient counselling/reassurance
- Vitrectomy with macula peel if sig symptoms
- Combined vity with mac peel and phaco
What ocular investigations should be conducted on VM disorders?
- Amsler
- OCT
- Photography (red-free will show sudden changes in vessel direction)
- FFA to exclude other causes
What is NICE guidance on the use of Jetrea in VM disorders?
Can be used if macula hole is <=400microns or there are severe symptoms and if ERM not present
What are the cons of Jetrea?
Has shown to loosen zonules in mice.
How are macula holes classified by size?
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
How are macula holes classified by cause?
Primary initiated by VMT Secondary due to disease or trauma
How are pseudo-holes different?
- Invaginated foveal edges
- Associated ERM
- No loss in retinal tissue
What is an ERM?
Fibrocellular proliferation contracting as a sheet over the surface of the ILM
How often are ERM’s bilateral?
10-35% of the time
What are the 5 ocular risks of developing an ERM?
- RD
- RVO
- DR
- Trauma
- Uveitis
What are the clinical signs of an ERM?
- Wrinkling of superficial light reflexes
- White, thick membrane structure visible
- Translucent membrane with distortion and angulation of retinal blood vessels
How many cases of VMT spontaneously resolve?
15-50%
What does jetrea target
Fibronectin laminin and collagen
How long after resolution do VMT symptoms continue after resolution?
6-9 months
How often does CMO occur after ICCE?
5-15%
What is the proposed pathogenesis of CMO?
Cytokines released by inflammatory cells break down blood-retinal barrier causing capillary leakage
What other proposed causes of CMO are there?
- VMT
- Vitreous inflammation
- Disc swelling
- Prostaglandin release in vitreous
- Lens removal
What factors put you at risk of CMO?
- Diabetes
- Capsular rupture
- ERM
- Previous uveitis, RVO or RD
What are the clinical signs of CMO?
- Macula thickening
- Loss of foveal depression
- 3-4 large central cysts
- Vitreous cells
- Central yellow spot
What FFA appearance will you see in CMO?
FFA will show leakage from perifoveal caps
Late leakage into fovea with a petalloid appearance
Mild optic disc leakage
What is the differential diagnosis of CMO?
- Diabetic maculopathy
- BRVO
- Exudative ARMD
- Radiation retinopathy
When should treatment be considered for CMO?
if Reduced v/a and clinical macula oedema
What are the treatments for CMO?
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
Why does acetazolamide work in CMO?
It increases the action or the RPE pump
What are the long terms complications of CMO?
Multiple remissions can result in photoreceptor death.
