Vitreoretinal

Question 1

What is a peripheral retinal degeneration?

Answer 1

Abnormalities in the peripheral retina

Question 2

What is the incidence of peripheral retinal degenerations?

Answer 2

Almost everybody has them to some degree but about 1 in 40 will develop retinal breaks

Question 3

List some important types of retinal degenerations

2

Answer 3

Lattice degeneration

Degenerative retinoschisis

Question 4

In Robin’s Greatly Immature Imagination Only Oiled Empresses Plays with Robin’s Bald Cock Correctly

Answer 4

Internal limiting membrane 
Retinal Nerve Fibre Layer
Ganglion Cell Layer 
Inner Plexiform Layer
Inner Nuclear Layer 
Outer plexiform layer
Outer Nuclear Layer 
External limiting membrane 
Photoreceptor Layer 
Retinal Pigment Epithelium 
Buchs Membrane 
Choriocapillaris 
Choroidal Stroma

Question 5

What is lattice degeneration?

Answer 5

Describes areas of thinning in the neurosensory retina (NSR) with overlaying vitreous liquefaction and vitreoretinal adhesions.

Characterised by circumferential zigzag white lines with oval holes within the lesion.

Question 6

What is lattice degeneration most strongly associated with?

Answer 6

Retinal tears

Question 7

What is the prevalence of lattice degeneration?

Answer 7

Present in about 6-10% of the population and more commonly in myopic eyes

Question 8

What percentage of patients presenting with acute rhegmatogenous retinal detachment has LD?

Answer 8

30%

Question 9

What group of patients with LD are offered prophylactic management?

Answer 9

Patients with retinal detachments in the contralateral eye

Question 10

What treatment is there for lattice degeneration?

Answer 10

Laser retinopexy

Question 11

What is degenerative retinoschisis?

Answer 11

A microcytic degeneration resulting in the splitting of the retinal layers between the outer plexiform and inner nucleus layers (usually inferotemproally)

It is mostly a bilateral and symmetrical condition

More common in hypermetropic eyes and no associated with a RRD

Question 12

What is an RRD?

Answer 12

Rhegmatogenous retinal detachment is the most common form of detachment and is characterised by accumulation of fluid between the neurosensory retina and underlying RPE

Question 13

What are the features of degenerative retinoschisis?

Answer 13

Smooth convex and immobile elevation of the retina with no demarcation line of chronicity as with RRD

Associated with absolute field defect

Question 14

What is a posterior vitreous detachment?

Answer 14

Is the separation of the posterior vitreous cortex from the NSR.

Question 15

What is the pathophysiology of PVD?

Answer 15

Occurs with increasing age as the vitreous becomes more liquefied (synchysis)

This causes empty spaces within the vitreous which collapse (syneresis)

This puts traction on the retina and can lead to a tear or a haemorrhage

Question 16

Describe the features of PVD

Answer 16

Photopsia (light flashes) with associated floaters. VA usually not affected

Weiss Ring: Thickened vitreous avulsed from the optic disc

Shafer sign (pigmented particles of tobacco dust in the anterior vitreous negative)

Question 17

Outline the management of PVD

Answer 17

Does not require treatment
Warn about risks of RRD and advise on presenting immediately if symptoms worsen or Visual fields affected

If complicated with retinal tear, treat with laser or cryoretinopexy