Vitreoretina and uveitis Flashcards
What proportion of people develop retinal breaks associated with peripheral retinal degeneration?
1/40
What sort of retinal degeneration is most closely associated with retinal tears?
lattice degeneration
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.
lattice degeneration
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.
degenerative retinoschisis
Which process causes age related liquefaction of the vitreous with empty fluid pockets?
vitreous syneresis
What percentage of simple PVDs are associated with retinal tears?
10%
What percentage of PVDs with vitreous haemorrhage are associated with retinal tears?
> 70%
Patient with temporal flashes and floaters. No change in VA. Weiss ring on fundoscopy. Shafer sign negative.
PVD
What is Shafer sign?
“tobacco dust”
Pigment floating around dur to retinal tear
True or false: complete PVD limits progression of diabetic retinopathy.
True
Vitreous is required for the development of proliferative diabetic retinopathy.
Flashes and floaters. Shafers sign positive. No decrease in visual acuity or visual field defect.
retinal break
What causes a retinal tear?
traction from PVD
What proportion of retinal tears progress to retinal detachment?
1/3
What is retinal dialysis?
disinsertion of the retina at the ora serrata
What are the two main causes of retinal dialysis?
idiopathic (inferotemporal)
trauma (superonasal)
What is the management for symptomatic retinal tear?
laser retinopexy
What is the management for retinal dialysis without retinal detachment?
laser retinopexy
What is the management for retinal dialysis with retinal detachment?
scleral buckle
What are the three types of retinal detachment?
rhematogenous
tractional
exudative
What sort of retinal detachment is associated with PVD?
rhematogenous
Flashes and floaters with associated relative field loss. RAPD, Weiss ring and shafer sign positive. U shaped retinal tear in superotemporal region.
rhematogenous RD
What features would you see with a chronic rhematogenous retinal detachment?
retinal thinning, demarcation lines, intraretinal cysts, proliferative vitreoretinopathy.
When would you do a B-scan in suspected rhematogenous RD?
no view of posterior pole e.g. cataract, vitreous haemorrhage
What is the management of rhematogenous RD?
pars plana vitrectomy
What conditions can cause tractional retinal detachment?
proliferative diabetic retinopathy
retinopathy of prematurity
What is the pathogenesis of tractional retinal detachment?
fibrovascular membranes cause progressive contracture over areas of adhesions eventually causing retinal detachment
No flashes or floaters. Relative visual field loss. Shallow, immobile concave tenting of the retina and proliferative diabetic retinopathy seen on fundoscopy.
Tractional RD
What structure must be affected before surgical management of tractional RD is considered?
macula
What is the management for tractional RD?
vitrectomy with membrane peel
What structure is damaged leading to build up of fluid between the NSR and RPE, resulting in exudative RD?
outer blood-retinal barrier
What conditions can cause exudative RD?
ARMD Coat's disease central serous chorioretinopathy Posterior uveitis (VKH) posterior scleritis
Is surgery indicated in exudative RD?
no- treat underlying cause