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Final Exam Peripheral Retinal Abnormalities
Dr. Lingel
97
Medical
Graduate
04/26/2012

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Cards

Term
What is the best way to view peripheral retinal abnormalities?
Definition
Scleral indentation
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
No
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
7
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
10 to 20
Term
What is often seen next to short ciliary nerves?
Definition
pigment clumping
Term
What delineates superior vs inferior retina in the periphery?
Definition
Long Ciliary Nerves
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
Over 40
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
OPL
Term
What is cystoid degeneration associated with?
Definition
retinoschisis between PR outer and inner segments?
Term
What is the tx of cystoid degeneration?
Definition
None, just monitor
Term
If you have a retinal hole associated with cystoid degeneration and it is less than 1DD, what is done?
Definition
monitor
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
Reduces the chance
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
inferior nasal
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
18% of all

bilateral
Term
What is an important ddx of reticular senile pigmentary degeneration?
Definition
retinitis pigmentosa
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
None
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
cystoid degeneration
Term
What is another term for vitreoretinal tufts?
Definition
granular tags
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
50.00000%
Term
What is the incidence of vitreoretinal tufts?
Definition
72% of all
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
1/2 to 4 DD
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
superior nasal
Term
If a meridional fold covers both bay and process, what is it called?
Definition
Meridional complex
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
posterior end
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
Meridional complex
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
yes
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
near equator along BV's
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
BV w/ thickened walls
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
increases w/age

myopia
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
All quadrants
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
edema
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
What is a pseudo hole?
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
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