Unit 7 - Benign lesions

Question 1

What is a congenital anomaly which has a loss of RPE, temporal to fovea pointing towards the fovea?

Answer 1

Torpedo maculopathy

Question 2

Which variant of CHRPE is of concern?

Answer 2

Multiple irregular CHRPE in all 4 qudrants that are pisciform in shape and bilateral. Linked to familial adenomatous polyposis

Question 3

Are CHRPE elevated?

Answer 3

May be minimally elevated

Question 4

Which associations are there with Angioid streaks?

Answer 4

P – PXE (ABCC6)
E - Ehlers Danlos syndrome (probably not_
P - Paget’s disease of bone
S- Sickle cell disease (and thalassaemia)
I – Idiopathic

Question 5

What are the four common types of haemangiomas

Answer 5

Capillary
Cavernous
Vasoproliferative
Racemouse

Question 6

Which haemangioma is more likely in VHL?

Answer 6

Capillary haemangioma

Question 7

Which haemangiomas either don’t respond to treatment or don’t need it?

Answer 7

Racemouse
Cavernous

Question 8

Which haemangioma is more likely if there is a history of ocular disease?

Answer 8

Vasoproliferative tumour of the ocular fundus

Question 9

How often does VHL present with a capillary haemangioma?

Answer 9

68%

Question 10

What types of choroidal haemangioma are there?

Answer 10

Diffuse
Circumscribed

Question 11

Which type of choroidal haemangioma has systemic associations?

Answer 11

Diffuse, may have other haemangiomas on fac and or Sturge-Weber

Question 12

What will a diffuse choroidal haemangioma look like on ultrasound?

Answer 12

HIgh reflectivity

Question 13

What signs would you see in a diffuse choroidal haemangioma?

Answer 13

Tortuous vessels, srf, subretinal fibrosis

Question 14

What types of hamartoma are there?

Answer 14

Simple
Astrocytic
Combined hamartoma of retina and rpe

Question 15

Which lesion is termed a mulberry lesion?

Answer 15

Astrocytic hamartoma

Question 16

Which hamartoma is due to glial proliferation?

Answer 16

Combined hamartoma of retinal and RPE

Question 17

What are the signs of a simple hamartoma?

Answer 17

retinal exudation and pigmented vitreous cells (20%)
Minimally dilated feeder vessels
solitary pigmented nodule

Question 18

In which layer of the retina is an astrocytic harmartoma located?

Answer 18

nerve fibre

Question 19

Which hamartomas may be asscoiated with NF?

Answer 19

Type 1 - astrocytic
Type 2 - Combined

Question 20

What does a choroidal osteoma look like?

Answer 20

Yellow well defined lesion
Looks like aero on FAF
Highly reflective on US

Question 21

How does vision loss occur with choroidal osteomas?

Answer 21

Bone de-calcifies and kills photoreceptors

Question 22

Which peripheral retinal degeneration has an association with RD and by how much?

Answer 22

Lattice - 1% risk of RD

Question 23

What types of Ret tels are there?

Answer 23

Coats,
Mac tel 1,2,3
Sickle cell

Question 24

Describe Coat’s disease?

Answer 24

Unilateral severe form of tel
Light bulb aneurysm, exudation, capillary dropout and fibrosis

Question 25

Which mac tel is congenital?

Answer 25

Type 1 - probably a form of Coats

Question 26

Which Mac Tel is associated with cerebrovasculopathy?

Answer 26

Type 3

Question 27

With which mac tel can you get CNVM?

Answer 27

Type 2

Question 28

Which mac tel patients retain good vision?

Answer 28

Type 1 - 6/12 ish

Question 29

If you see drusen in young people what do you want to check for?

Answer 29

Membranoproliferative glomerulonephritis type 2

Question 30

Which patients are more likely to get choroidal melanoma?

Answer 30

White, fair, blue eyed men with NF1, BAP gene with a naevus of ota and are welders!

Question 31

What is the mortality of choroidal melanoma?

Answer 31

50% at 5 years

Question 32

What treatment is more successful plaque brachytherapy or enucleation?

Answer 32

Equally

Question 33

Is choroidal melanoma similar to cutaneous melanoma?

Answer 33

No different disease

Question 34

what types of retinoblastoma are there?

Answer 34

Exophytic, subretinal growth Endophytic, growth into virtreous cavity

Question 35

How can you differentiate Coats from exophytic retinoblastoma?

Answer 35

Don't get lightbulb telangiectasia in retinoblastoma

Question 36

Which type of retinoblastoma simulates Coats?

Answer 36

Exophytic

Question 37

What is the survival in retinoblastoma?

Answer 37

95%, worse if extraocular

Question 38

Which mac tel is bilateral?

Answer 38

Type 2, and type 3

Question 39

What features does Alport syndrome have?

Answer 39

Kidney failure Deafness Corneal RE Dot and fleck retinopathy Mid peripheral flecks Temporal macular thining Anterior lenticonus

Question 40

What is the genetics in Alport syndrome?

Answer 40

X-linked 85% 15% AR AD is very rare

Question 41

Who gets adult onset vitelliform macular dystrophy and why?

Answer 41

women in their 30-40s May be heriditary trait Yellow material is thought to be lipofuscin and photoreceptor debris

Question 42

What will the FFA show with adult onset vitelliform macular dystrophy

Answer 42

Hyper fluorescent staining with a corona sign present

Question 43

What is the prognosis in adult onset vitelliform macular dystrophy?

Answer 43

VA quite good until GA develops

Question 44

What is the diff dx in AFMVD

Answer 44

Best's disease but would be present earlier AMD but AFMVD lesions appear earlier and have more discrete sub-foveal deposits

Question 45

What symptoms do you get with primary intraocular lymphoma?

Answer 45

Vitreous floaters Systemic history of lymphoma

Question 46

What are the sign in primary intraocular lymphoma?

Answer 46

Subretinal yellow infiltrates VA better than signs Mean age 50-60 60-80% develop intracranial lymphoma within 29 months

Question 47

What is often the problem in primary intraocular lymphoma?

Answer 47

Treated as a uveitis with steroids. Need to be off steroids for 2 weeks before biopsy

Question 48

What percentage of uveal metastases are choroidal?

Answer 48

88%