Term
| What is the best way to view peripheral retinal abnormalities? |
|
Definition
|
|
Term
| What is 'rolling the retina'? |
|
Definition
| Massaging the elevation of the retina with a scleral indenter |
|
|
Term
| When should scleral indentation NOT be performed? |
|
Definition
penetrating trauma
recent ocular surgery
Certain IOL's (rare now though)
uncontrolled very high IOP |
|
|
Term
| Can you cause a RD via scleral indentation? |
|
Definition
|
|
Term
| What part of the crystalline lens are we looking through in scleral indentation? |
|
Definition
Periphery --> abberations and distortions
3 mirror fundus gonio avoids this |
|
|
Term
| What is the avg # of vortex veins per eye? |
|
Definition
|
|
Term
| What is often seen next to vortex veins? |
|
Definition
| RPE pigmentation clumps tend to associate here |
|
|
Term
| How many short ciliary nerves are there per eye? |
|
Definition
|
|
Term
| What is often seen next to short ciliary nerves? |
|
Definition
|
|
Term
| What delineates superior vs inferior retina in the periphery? |
|
Definition
|
|
Term
| What does temporal ora serrata look like compared to nasal? |
|
Definition
Smoother than nasal
"When you furrow your brow, the glabella is more furrowed" |
|
|
Term
| What is a good way to know you are at the ora serrata? |
|
Definition
| BV's do not go through dark areas of ora serrata, they change course to avoid hitting the ora |
|
|
Term
| What is an enclosed oral bay? |
|
Definition
| It appears as a retinal hole (they are red) with a white border |
|
|
Term
| How do you ddx an enclosed oral bay? |
|
Definition
| With scleral indentation the enclosed oral bay will be tightly attached 360*, retinal holes will not be |
|
|
Term
| Where does the vitreous attach peripherally? |
|
Definition
| Onto the ora serrata and retina |
|
|
Term
| What presents as 'shimmering white' or darkly pigmented in the periphery? |
|
Definition
| Where the vitreous base attaches |
|
|
Term
| What can cause a darkly pigmented vitreous base? |
|
Definition
| Vitreous tugs on retina --> RPE hyperplasia --> RPE pigment |
|
|
Term
| What is cystoid degeneration? |
|
Definition
Looks like tiny bubbles (cysts) next to ora serrata, but under vitreous base
Caused by thickened retinal tissue |
|
|
Term
| How can cystoid degeneraiton appear? |
|
Definition
salt and pepper'
slightly opaque
white with pressure |
|
|
Term
| Where does cystoid degeneration usually present? |
|
Definition
Bilateral superior temporal
Can extend to equator or the processes |
|
|
Term
| At what age does cystoid degeneration commonly appear? |
|
Definition
|
|
Term
| What is the pathophysiology of cystoid degeneration? |
|
Definition
| cystoid spaces form between retinal layers in the OPL |
|
|
Term
| What layer of the retina are cystoid degenerations found in first? |
|
Definition
|
|
Term
| What is cystoid degeneration associated with? |
|
Definition
| retinoschisis between PR outer and inner segments? |
|
|
Term
| What is the tx of cystoid degeneration? |
|
Definition
|
|
Term
| If you have a retinal hole associated with cystoid degeneration and it is less than 1DD, what is done? |
|
Definition
|
|
Term
| When should a retinal hole associated with cystoid degeneration pt RTC? |
|
Definition
| 6 mo if the hole is stable after 3 months |
|
|
Term
| Does a retinal hole increase or decrease the chance of RD in cystoid degeneration? |
|
Definition
|
|
Term
| What is 'white with and w/o pressure'? |
|
Definition
Appears like spilled milk or frosting on the retina
flat with no elevation
Scleral indentation increases the 'whiteness' if 'with pressure' |
|
|
Term
| What does having 'white with pressure' indicate vs 'white w/o pressure'? |
|
Definition
| White with pressure is the same pathology, just less advanced |
|
|
Term
| Does 'white with or w/o pressure' appear raised? |
|
Definition
| Yes, but it is NOT. Optical illusion |
|
|
Term
| Who has 'white with or w/o pressure' more often? |
|
Definition
32% of all
increases with age
more commonly SEEN in deeply pigmented race |
|
|
Term
| Where is 'white with or w/o pressure' most often present? |
|
Definition
between ora and equator
Can extend to posterior pole |
|
|
Term
| What is the least common location for 'white with or w/o pressure' seen? |
|
Definition
|
|
Term
| Will 'white with or w/o pressure' appear the same every time? |
|
Definition
| No, it can vary from day to day depending on vitreal traction, etc. |
|
|
Term
| What is pavingstone degeneration? |
|
Definition
| It is NOT a retinal hole, it is a THINNING of the retina |
|
|
Term
| What is the elevation of pavingstone degeneration? |
|
Definition
| Appears excavated (thinned) |
|
|
Term
| What is the appearance of pavingstone degeneration? |
|
Definition
| White circular hole (sclera) from 1/10 DD to several DD in size |
|
|
Term
| Where is pavingstone degeneration most commonly located? |
|
Definition
| 80% inferotemporal between ora and equator |
|
|
Term
| What is the incidence of pavingstone degeneration? |
|
Definition
22% of all
increases w/ age |
|
|
Term
| What is the cause of pavingstone degeneration? |
|
Definition
| infarcts in the choriocapillaris |
|
|
Term
| Can pigment clumps appear in pavingstone degeneration? |
|
Definition
| Yes, in a scallop pattern near the edge |
|
|
Term
| What are important DDX from pavingstone degeneration? |
|
Definition
toxoplasmosis
histoplasmosis |
|
|
Term
| How is histo ddx'ed from pavingstone degeneration? |
|
Definition
histo is less symmetric
more unilateral
in posterior pole |
|
|
Term
| What is reticular senile pigmentary degeneration? |
|
Definition
| a net-like pigment mosaic on the retina |
|
|
Term
| What is the incidence of reticular senile pigmentary degeneration? |
|
Definition
|
|
Term
| What is an important ddx of reticular senile pigmentary degeneration? |
|
Definition
|
|
Term
| What is the pathophysiology of reticular senile pigmentary degeneration? |
|
Definition
| RPE pigment deposited near retinal venules --> pigment cuffing |
|
|
Term
| What is the tx of reticular senile pigmentary degeneration? |
|
Definition
|
|
Term
| What is a vitreoretinal tuft? |
|
Definition
| elevated white/gray granular clump on retinal surface |
|
|
Term
| What is often seen next to vitreoretinal tufts? |
|
Definition
|
|
Term
| What is another term for vitreoretinal tufts? |
|
Definition
|
|
Term
| Why are vitreoretinal tufts dangerous? |
|
Definition
| The vitreous is often attached --> vitreal traction --> RD |
|
|
Term
| Where are vitreoretinal tufts most commonly seen? |
|
Definition
| nasal posterior to ora in vitreous base |
|
|
Term
| How often is vitreoretinal tufts seen bilaterally? |
|
Definition
|
|
Term
| What is the incidence of vitreoretinal tufts? |
|
Definition
|
|
Term
| What kind of cells are found in vitreoretinal tufts? |
|
Definition
| degenerated retina OR proliferated glial cells |
|
|
Term
| What is the tx for vitreoretinal tuft? |
|
Definition
ensure no holes/RD
If there are risks of RD (fluid cuffs), photocoagulation or cryopexy |
|
|
Term
| What is an important way to see vitreoretinal tufts during BIO? |
|
Definition
| Do circular motion with handheld lens to induce a shadow/parallax |
|
|
Term
| What is done if there are holes present at the base of a vitreoretinal tuft? |
|
Definition
| Monitor q 3 mo, q 6 mo if stable |
|
|
Term
| What are associated s/sx that indicate referral for tx in vitreoretinal tufts? |
|
Definition
complaints of flashing lights
pigment in vitreous
RD in fellow eye |
|
|
Term
| What is a meridional fold? |
|
Definition
| radially oriented redundant, folded retina that is whiter, slightly elevated section of peripheral retina perpendicular to ora |
|
|
Term
| What is the only way to get pigment in the vitreous? |
|
Definition
| If there is a hole in the retina washing pigment from RPE --> inner retina layers |
|
|
Term
| What is the typical length of meridional folds? |
|
Definition
|
|
Term
| What are meridional folds commonly aligned with? |
|
Definition
processes 81% of the time
Can align with the bays |
|
|
Term
| What is the incidence of meridional folds? |
|
Definition
20% of all
bilateral 50%
male > female
27% have multiple folds |
|
|
Term
| Where are meridional folds most often found? |
|
Definition
|
|
Term
| If a meridional fold covers both bay and process, what is it called? |
|
Definition
|
|
Term
| What is the cause of a meridional fold? |
|
Definition
congenital
increases with age |
|
|
Term
| If holes are found in a meridional fold, where is the hole usually located? |
|
Definition
|
|
Term
| What complication can a meridional fold cause? |
|
Definition
| RD, especially in temporal quadrant |
|
|
Term
| What kind of meridional fold has increased risk of holes? |
|
Definition
|
|
Term
| What is the tx/management of meridional folds? |
|
Definition
scleral indentation
FU q 3 mo if hole/tag present
Cryopexy if risky |
|
|
Term
| What is lattice degeneration? |
|
Definition
| circumferential or elliptical lesion |
|
|
Term
| What is 'classic' lattice degeneration? |
|
Definition
criss cross of white lines
6-9% of all lattice degeneration |
|
|
Term
| What is the size of lattice degenerations? |
|
Definition
| 1/4 to 1/3 DD up to 1DD to one quadrant in length |
|
|
Term
| Can lattice degenerations have pigmented borders? |
|
Definition
|
|
Term
| What is the incidence of lattice degeneration? |
|
Definition
6-10% of all
Bilateral 50% |
|
|
Term
| Where is lattice degeneration most often seen? |
|
Definition
| vertical meridians (5-7 and 11-1) |
|
|
Term
| If lattice degeneration follows retinal BV, what variant is it? |
|
Definition
| radial lattice --> more dangerous |
|
|
Term
| Where is radial lattice degeneration usually found? |
|
Definition
|
|
Term
| What is the pathophysiology of lattice degeneration? |
|
Definition
| atrophic retinal thinning --> pigment cavity |
|
|
Term
| What are the white lines seen in 'classic' lattice degeneration? |
|
Definition
|
|
Term
| How does the vitrous attach to a lattice degeneration? |
|
Definition
Firm at the borders
liquefaction above lesion
'Tents' over the lesion like a blister |
|
|
Term
| When is lattice degeneration most often seen? |
|
Definition
|
|
Term
| What is the major risk of vitreal tenting seen in lattice degeneration? |
|
Definition
| Vitreous liquefies --> goes through hole in retina --> RD!! |
|
|
Term
| What are the fine white specks seen in lattice degeneration made of? |
|
Definition
| fragmented inner retinal layer tissue |
|
|
Term
| What happens if vitreous tugs on the BV surrounded by radial lattice degeneration? |
|
Definition
| Acts as a 'tear strip' and rips a line through the retina (lifesaver opening string) |
|
|
Term
| What is the management of lattice degeneration? |
|
Definition
If holes --> laser prophylaxis
If history of RD --> prophylactic laser
cataract surgery requires retinal evaluation |
|
|
Term
| What is an atrophic retinal hole? |
|
Definition
A round, discrete pink or red hole that has been worn away
'thinned sock' analogy |
|
|
Term
| Where are atrophic retinal holes often found? |
|
Definition
|
|
Term
| If there is a lattice degeneration lesion over a retinal hole, what is of higher risk? |
|
Definition
| If the hole is crossed by the border of the lattice degeneration --> much higher RD risk |
|
|
Term
| What do 'fluid cuffs' look like? |
|
Definition
| A ring of fluid under the retina |
|
|
Term
| What can 'fluid cuffs' look like, but are not? |
|
Definition
|
|
Term
| Are atrophic retinal hole associated with RD? |
|
Definition
| No, because vitreous is not attached to the atrophic retinal hole |
|
|
Term
| When are fluid cuffs associated with a higher risk of RD? |
|
Definition
| If they are superior (gravity pulls down) |
|
|
Term
|
Definition
| When a 'white w/o pressure' extends almost to the macula, so the intact retina appears red in comparison, but it is not a retinal hole |
|
|
