Retina Review

Part 1

80 yo 20/100

83 yo male 20/200

AMD: Neovascular
Define classic choroidal neovascularization
Early, bright uniform hyperfluorescence (within 30
seconds) exhibiting leakage in the late frames

72 yo 20/60 OD

AMD: Neovascular
Define the two types of occult choroidal
neovascularization
Fibrovascular PED: early stippled hyperfluorescence (within
first minute) exhibiting leakage or staining in the late frames
Late leakage of undetermined etiology: late speckled
hyperfluorescence with no corresponding source in the early
frames

63 yo c/o needs stronger reading glasses, 20/40

88 yo CF OD

AMD: Prevention
Summarize results of the AREDS Study
Beneficial subgroups:
Intermediate AMD in both eyes or advanced AMD
in one eye
5-year risk of progression to advanced AMD:
Placebo:
28%
Antioxidants + Zinc: 20%
Formulation:
Vitamin C
500mg
Vitamin E
400IU
Beta carotene
15mg
Zinc
80mg

AMD: Treatment
MPS Study - Thermal laser beneficial for extrafoveal and
juxtafoveal classic lesions
TAP Study - PDT beneficial for classic subfoveal lesions
VIP Study - PDT slightly beneficial at 2 years for purely
occult subfoveal lesions
MARINA - Lucentis beneficial for minimally classic lesions
ANCHOR - Lucentis beneficial for predominantly classic
lesions

47 yo recent distorted vision OS

OHS
Describe the clinical triad of OHS.
Punched out chorioretinal lesions (histo spots)
Peripapillary atrophy
Choroidal neovascularization

What is the endemic geographic region?

Mississipi and Ohio River Valley

50 yo male h/o
pseudoxanthoma
elasticum

Angioid Streaks
What are systemic diseases associated
with angioid streaks?

Pseudoxanthoma elasticum
Ehlers-Danlos syndrome
Pagets disease of bone
Sickle cell disease
Idiopathic

50 yo long time contact lens wearer

Pathologic Myopia
What is the commonly accepted definition based
on axial length and refractive status?
Axial length > 26mm
Spherical equivalent < -8.00D

What is the spectrum of fundus findings?

Lacquer cracks
Subretinal hemorrhage
Fuchs spot
Posterior staphyloma
RPE/choroidal atrophy
Cystoid, paving-stone, lattice degeneration
Retinal thinning/holes
Scleral thinning
CNV

33 yo business consultant, distortion OS, 20/25

CSC
How is the characteristic patient described?
Healthy male, 30-50 yo, type-A personality

What is the most common angiographic finding?

Small, focal hyperfluorescent RPE leak

How frequently does a smokestack occur?

10%

What is the rate of spontaneous resolution of

subretinal fluid?
80-90%

What is the recurrence rate?

40-50%

CSC
What are indications for laser
photocoagulation?
Persistence of serous detachment >3-4mo
Recurrence in eyes with visual deficit from prior
episode
Presence of permanent visual deficit in fellow
eye from prior episode
Development of chronic signs (cystic change in
retina; widespread RPE abnormalities)
Occupational need

50 yo 20/50 OS

Epiretinal Membrane
What are the clinical findings?

Metamorphopsia & decreased acuity

Retinal striae
Subretinal fluid or cystic change
Almost always associated with PVD

What is the incidence of bilaterality?

20%

What percentage of eyes maintain vision 20/50

or better?
75%

60 yo 20/100

VMT
What are the clinical findings?
Metamorphopsia and decreased vision
Partial posterior vitreous detachment
Vitreous traction on the macula with
subretinal fluid accumulation or CME

55 yo, 20/200
(not from glx)

Macular Hole
Describe the 4 stages of macular hole

Ia:
II:
III:
IV:

foveolar detachment
full-thickness defect <400m
full-thickness defect >400m, no PVD
stage III with PVD

What is the incidence of bilaterality?

10-20%

70 yo 5 wk s/p CE with vit loss, 20/80

CME
In what histologic layer does fluid collect?
Outer plexiform

What are common causes?

Postoperative
Uveitis
Retinal venous occlusive disease
Choroidal neovascularization
Epiretinal membrane/VMT
Retinitis pigmentosa

What is the incidence of clinical CME following

extracapsular CE with intact capsule?
<1%

What percentage of cases spontaneously

resolve?
95%