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Duke Elder > Vitreoretina and uveitis > Flashcards

Vitreoretina and uveitis Flashcards

1
Q

What proportion of people develop retinal breaks associated with peripheral retinal degeneration?

A

1/40

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2
Q

What sort of retinal degeneration is most closely associated with retinal tears?

A

lattice degeneration

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3
Q

Thinning of neurosensory retina with vitreous liquefaction and vitreoretinal adhesions. Characterised by circumferential zigzag white lines with round holes within the lesion. More common in myopes. Associated with rhematogenous retinal detachment.

A

lattice degeneration

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4
Q

Splitting of retinal layers between outer plexiform and inner nuclear layers. More common in hypermetropes. Often bilateral and symmetrical in inferotemporal quadrants. Smooth immobile convex elevation of retina. Absolute field defect.

A

degenerative retinoschisis

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5
Q

Which process causes age related liquefaction of the vitreous with empty fluid pockets?

A

vitreous syneresis

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6
Q

What percentage of simple PVDs are associated with retinal tears?

A

10%

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7
Q

What percentage of PVDs with vitreous haemorrhage are associated with retinal tears?

A

> 70%

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8
Q

Patient with temporal flashes and floaters. No change in VA. Weiss ring on fundoscopy. Shafer sign negative.

A

PVD

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9
Q

What is Shafer sign?

A

“tobacco dust”

Pigment floating around dur to retinal tear

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10
Q

True or false: complete PVD limits progression of diabetic retinopathy.

A

True

Vitreous is required for the development of proliferative diabetic retinopathy.

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11
Q

Flashes and floaters. Shafers sign positive. No decrease in visual acuity or visual field defect.

A

retinal break

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12
Q

What causes a retinal tear?

A

traction from PVD

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13
Q

What proportion of retinal tears progress to retinal detachment?

A

1/3

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14
Q

What is retinal dialysis?

A

disinsertion of the retina at the ora serrata

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15
Q

What are the two main causes of retinal dialysis?

A

idiopathic (inferotemporal)

trauma (superonasal)

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16
Q

What is the management for symptomatic retinal tear?

A

laser retinopexy

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17
Q

What is the management for retinal dialysis without retinal detachment?

A

laser retinopexy

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18
Q

What is the management for retinal dialysis with retinal detachment?

A

scleral buckle

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19
Q

What are the three types of retinal detachment?

A

rhematogenous
tractional
exudative

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20
Q

What sort of retinal detachment is associated with PVD?

A

rhematogenous

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21
Q

Flashes and floaters with associated relative field loss. RAPD, Weiss ring and shafer sign positive. U shaped retinal tear in superotemporal region.

A

rhematogenous RD

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22
Q

What features would you see with a chronic rhematogenous retinal detachment?

A

retinal thinning, demarcation lines, intraretinal cysts, proliferative vitreoretinopathy.

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23
Q

When would you do a B-scan in suspected rhematogenous RD?

A

no view of posterior pole e.g. cataract, vitreous haemorrhage

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24
Q

What is the management of rhematogenous RD?

A

pars plana vitrectomy

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25
What conditions can cause tractional retinal detachment?
proliferative diabetic retinopathy | retinopathy of prematurity
26
What is the pathogenesis of tractional retinal detachment?
fibrovascular membranes cause progressive contracture over areas of adhesions eventually causing retinal detachment
27
No flashes or floaters. Relative visual field loss. Shallow, immobile concave tenting of the retina and proliferative diabetic retinopathy seen on fundoscopy.
Tractional RD
28
What structure must be affected before surgical management of tractional RD is considered?
macula
29
What is the management for tractional RD?
vitrectomy with membrane peel
30
What structure is damaged leading to build up of fluid between the NSR and RPE, resulting in exudative RD?
outer blood-retinal barrier
31
What conditions can cause exudative RD?
``` ARMD Coat's disease central serous chorioretinopathy Posterior uveitis (VKH) posterior scleritis ```
32
Is surgery indicated in exudative RD?
no- treat underlying cause
33
What are the two main processes which result in vitreous haemorrhage?
trauma | neovascularisation
34
What are the management options for vitreous haemorrhage?
if fundus visualised- pan-retinal photocoagulation no fundal view or wet ARMD- intravitreal vegf non-clearing haemorrhage or RD- vitrectomy
35
What is Terson syndrome?
subarachnoid haemorrhage, 10% go on to develop vit haem
36
Choroidal detachment can occur due to hypotony. What can cause low IOP?
glaucoma surgery | trauma
37
Smooth convex dome of dark retina. Kissing choroidals.
choroidal detachment
38
Is the NSR affected in choroidal rupture?
no- choriocapillaries, Bruch membrane and RPE affected
39
Hx blunt trauma. Crescent shaped yellow subretinal streak seen concentric to the optic disc.
choroidal rupture
40
Middle aged, hypermetropic man with nanophthalmos. Leopard mottling of RPE. Exudative RD.
Uveal effusion syndrome
41
What classification system is used in macular hole? What investigation is this system based on?
IVTS | OCT
42
Where is the choroid located?
between the sclera and RPE
43
What 2 layers make up the choroid?
Bruch membrane | Vascular layer
44
What structures are inflamed in anterior uveitis?
iris and pars plicata
45
How long does an anterior uveitis need to be present to be "chronic"?
3 months
46
What sort of KPs are present in granulomatous anterior uveitis?
mutton fat KPs
47
What sort of KPs are present in non-granulomatous anterior uveitis?
stellate KPs
48
What proportion of anterior uveitis is idiopathic?
50%
49
What infections are associated with anterior uveitis?
TB lyme disease syphilis VZV
50
Painful red eye and photophobia. Irregular miosed pupil. KPs and hypopyon.
anterior uveitis
51
What drugs are used to manage anterior uveitis?
potent topical steroids and cyclopentolate to dilate pupil
52
what complication can occur with anterior uveitis?
cystoid macular oedema
53
What structures are inflamed in intermediate uveitis?
pars plana and vitreous
54
What inflammatory conditions are associated with intermediate uveitis?
sarcoidosis, MS, IBD
55
Blurred vision and floaters. Snow balls and snow banks. Peripheral periphlebitis.
intermediate uveitis
56
What structures are affected in posterior uveitis?
choroid and retina
57
What inflammatory conditions are associated with posterior uveitis?
sympathetic ophthalmia, VKH, birdshot choroidopathy, sarcoidosis, Behcet's
58
What infections are associated with posterior uveitis?
toxoplasmosis, onchocericiasis (river blindness), tococariasis, syphilis, TB, VZV, HSV, CMV
59
What are the complications of intermediate uveitis?
CMO, optic disk swelling, glaucoma, cataracts
60
Granulomatous condition associated with ant, int, post and pan uveitis. Ocular signs of uveitis plus Lader sign (panretinal granuloma - SPECIFIC). CXR: bilateral hilar lymphadenopathy Serum ACE elevated
sarcoidosis
61
Infectious condition associated with ant and post uveitis and dacryoadenitis. Night sweats, weight loss and haemoptysis. Acid fast bacilli on Ziehl Neelsen satain
TB
62
Bilateral granulomatous panuveitis due to Tcell response against melanocytes, melanin and the RPE. No macular odema. Dalen Fuch nodules, sugiura sign (depigmented limbus), sunset glow fundus, exudative RD. Extraocular features include alopecia, vitiligo, sensorineural hearing loss and meningitis. Associated with HLA-DR4 and HLA-B22. Most commonly seen in the Japanese population.
Vogt Koyangi Harada (VKH)
63
Bilateral granulomatous panuveitis following trauma( can be prev. ocular surgery). Associated with HLA-A11 and HLA- DR4. No extra-ocular features.
sympathetic ophthalmia
64
What is surgical management of sympathetic ophthalmia?
enucleation- prevents other eye from developing symptoms
65
Chronic bilateral posterior uveitis with hypopigmented lesions. Insidious impairment of central vision with floaters and flashes. Nyctalopia and moderate vitritis. Bilateral oval cream coloured ill defined lesions in posterior pole and mid periphery. 95% of patients HLA-A29 positive.
Birdshot choroidopathy
66
Paediatric patient with oligoarthritis present for >6 weeks. Fever and rash. Associated with HLA-DR5. ANA positive in 75%.
Juvenile idiopathic arthritis
67
What infections can lead to Reiter syndrome?
chlamydia shigella salmonella yersinia
68
What is the triad of symptoms in Reiter syndrome?
conjunctivitis, urethritis and arthritis
69
Which HLA class is associated with Reiter syndrome?
HLA-B27
70
Turkish patient with anterior uveitis and mobile hypopyon (pathogenomic). Recurrent oral and genital ulcers. Pulmonary artery aneurysm. Associated with HLA-B5 and HLA-B51
Behcet's disease
71
Child with fever lasting >5 days, unresponsive to paracetamol. Bilateral conjunctival injection with limbal sparing. Bilateral anterior uveitis. Strawberry tongue and shedding rash on hands and feet.
Kawasaki disease
72
What is the treatment for Kawasaki?
aspirin and immunoglobulins
73
What is the treatment for Behcets?
steroids and anti-TNF
74
Unilateral endophthalmitis in young child with a pet cat. Leukocoria, stabismus and visual loss. Anterior uvitis and pars planitis. No calcification on CT.
toxocariasis
75
At what CD4 count do HIV patients become susceptible to toxoplasmosis?
<200
76
What is the management of toxoplasmosis?
pyremethamine, sulfadiazine and corticosteroid
77
Yeast infections resulting in loss of vision occuring in Ohio river Mississippi valley. More common in aids patients. Multiple white atrophic punched out chorioretinal scars, peripapillary atrophy and absent vitritis.
presumed ocular histoplasmosis syndrome (POHS)
78
At what CD4 count do HIV patients become susceptible to CMV retinitis?
<50
79
Full thickness retinal inflammation with necrosis. Rapid visual loss, pizza pie retina, periphlebitis, mild/moderate vitritis.
CMV retinitis
80
What is the treatment for CMV retinitis?
IV Ganciclovir

Duke Elder (8 decks)

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