what test do you need to interpret ERG
what is the characteristic vascular change of DR
loss of pericytes and basement membrane thickening -> capillary occlusion and subsequent nonperfusion
summarize the finding of VISION (VEGF inhibition study in Ocular Neovasulirazation)
less chance of moderate vision loss in 1 year for the pegaptanib (macugen) group compared to placebo
findings of MARINA (minimally classic/occult trial of the anti-VEGF antibody ranizumab in the treatment of neovascular amd)
less chance of 15 letter loss and more chance of letters gained in the ranibizumab group compared to placebo for minimally classic/occult lesions
findings of CATT (complications of age related mac degen treatment trial)
bevacizumab (avastin) monthly and prn was equivalent to ranibuzimab monthly and prn
findings of View-1 and 2 studies
aflibercept was noninferior to monthly ranibuzimab and had a similar safety profile
what's in areds
"vit C, vit E, beta carotene, zinc ozide, cupric oxide"
what part of areds is CI for smokers and why
beta carotene because of higher risk of lung cancer
what retinal antigen causes CAR
what vegf isoform is most pathologic in neovascular amd and what drug targets it
"vegf 165, macugen"
what are the exam and diagnostic findings of mewds
"macular pigment stippling, macular wreath-like punctate hyperfluoresence on FA, mild disc edema"
what is a prominent clinical finding of mewds
what are findings of fabry's disease
"cornea verticillata, abnormally dilated conjunctival vessels, retinal vessel tortuosity"
what is the cause of fabry's disease
mutation in alpha-galactosidase A gene -> accumulation of ceramide trihexoside
which mitochondrial diseases are x-linked?
"fabry's and hunter syndrome; think of a ""fabulous"" hunter aiming at target shaped like x"
what is cause of tay-sachs disease
deficiency of hexosaminidase A
cause of gaucher's disease
deficiency of glucocerebrosidase
cause of neimann pick
deficiency of sphingomyelinase
what are classic manifestations of VKH syndrome
"suguira sign (perilimbal vitiligo in the uveitic phase), dalen fuch nodules (punched out lesions, occur in 1/3), neck pain, tinnitus, dysacusis, flu-like illness"
what is anterior persistent fetal vasculature
"hylaoid artery remians -> white retrolental mass; associated signs are microphthalmos, shallow AC, long ciliary processes -> poor prognosis due to glaucoma, secondary cataract, deprivational ambylopia"
disadvtnages of using a 25g vs 20g vitrectomy
"risk of retinal tears, endolphthalmitis, hypotony -> this is due to not suturing the small incisions"
patients with NON subfoveal geographic atrophy benefit from AREDS
what 3 main questions did edtrs address
1. is focal good for DME 2. is early scatter photocoagulation good for earlier stages of DR 3. can asa delay progression of DR
"in erg, what cells does the b wave correspond to"
bipolar and mueller cells
what is found in von-hippel disease
"capillary hemangiomas in the retina (or retinal hemangioblastoma), cerebellar hemangioblastomas, pheochromocytomas, renal cell carcinoma, spinal cord tumors and cysts"
"what exam findings and features distinguish cone dystorphy from other congenital color deficiencies (deuteranopia, tritanopia, protanopia)"
"symmetric bulls eye maculopathy, mild to severe temporal optic atrophy, signs of progressive disease, decreased VA, day blindness, photophobia"
"according to bvos, when should you do scatter photocoagulation"
"neovascularization; if >5 Das of non-perfusion present, you should do close observation in 4 month intervals to r/o NV"
how do colobomas form
incomplete closure of the embryonic fissure at week 5 (normal closure begins at inferior equator and proceeds anteriorly and posteriorly
what drugs predispose to solar retinopathy
psoralen and tetracycline
what are newest guidliens for chloroquine toxocity
10-2 and either ERG/OCT/FAF
"according to CRUISE study, what is the initial treatment for CRVO"
ranizumab injection qmonthly x 6 months
what are the most common FA findings of csr
expanding dot pattern > smokestack pattern > diffuse pattern
"once hydrochloroquine is stopped, can further vision loss occur"
what is stickler syndrome
"autosomal dominant disease characterized by optically empty vitreous cavity due to premature vit breakdown -> high incidence of RD (lattice and retinal thinning), cataract, glaucoma, strabismus; associated with facial dysgenesis in Pierre Robin sequence with micrognathia, cleft palate, glossoptosis, hyperflexibility, arthritis"
when do you start steriods in toxo
3 days after abx tx
what treatment can you give noncompliant toxo patients
intravitreal clindamycin and dexamethasone
what layer of retina are drusen
extending between bruchs and rpe
what hla associated with pars planitis? Birdshot? Behects?
"HLA-dr2, hla-a28, hla-b51"
"what disease causes corneal and conjunctival crystals, patchy retinopathy, and renal failure"
what is meridonal fold
"redundant peripheral retina that project into vitreous, mostly in superonasal quadrant, increased risk of rd"
what is parinaud's ocularglandular syndrome
"granulomatous nodules in the palpebral conj, ipsilateral preauricular or submandibular adenopathy, occurs in 10% of cat scratch"
what causes irvine gass syndrome
inflammation induced blood-retina barrier breakdown since postaglandins disrupt blood vessel integrity resulting in leakage of fluid in macula
how can you differentiate POHS and MCP?
MCP has vitritis while POHS doesnt
what FB material is most toxic to the eye
what is chalcosis and what are signs of it
"copper toxicity; deposits in Descemet's, sunflower cataract, greenish color iris, brown vitreous opacities, metallic flecks on retinal vessels"
what type of bacteria is bartonella henselae
what makes up internal limiting membrane
footplate of Muller cells (nucleus located in inner nuclear layer)
what cell nuclei making up inner nuclear layer
"Muller cells, bipolar cells, horizontal cells, amacrine cells"
what are risk factors for aMD
"age, cigarette smoking, light iris color, hyperopia, hypertension, high chol, female, fam history"
what are erg findings of iron toxicity (siderosis)
loss of amplitude of b-waves on erg eventually can be extinguished
what are fundus characteristics of stargardt's disease
"yellow parafoveal ""pisciform"" flecks and a ""beaten bronze"" macula"
what is the FA finding of stargardts
dark choroid due to blocking since lipofuscin like material accumulates in RPE
what is stargardts
inherited juvenile onset rod-cone dystrophy that causes progressive vision loss to 20/50-20/200
what disease do you see fluorescein quenching
birdshot; idiopathic rapid fluorescein clearing
what disease do you see patchy delayed choroidal filling
"choroidal ischemia in GCA, hypertensive choroidopathies, wegener associated choroidopathy"
what mutation in stargartdts
what is tx for RMA
photocoagulate if macular edema; observatino otherwise
what are erg/eog findings of best
"normal erg, abnormal EOG ALWAYS no matter the time period"
what are ocular and systemic findings of bardet-biedl syndrome
"macular pigment mottling, pigmentary retinopathy like RP, polydactyl, poor night vision, obese, mental retardation, hypogonadism, renal failure"
what's the difference between bardet-biedl and lawrence moon syndrome
along the same spectrum; lawrence moon has spastic paraplegia and NOT polydactyll
what are findings of alstrom syndrome
"AR d/o, tapetoretinal degeneration, obesity, DM, hearing loss, renal failure, dilated cardiomyopathy; CENTRAL VISION LOSS EARLY "
what visual acuity findings separate alstrom syndrome and other pigmentary retinopathy
central losss of vision early while others you lose peripheral vision first
what allergic reactino do you have to ask for to get ICG
iodide and shellfish allergies
why should you not repair small extremely posterior scleral lacerations?
extreme duction can cause vitreous prolapse through the wound
what are indications for repair of RRD with pneumatic retinopexy
"tear is at superior 8 clock hours, clear media, confidence that all breaks found, absence of PVR grade C and D"
"what is ddx of disruption of normal inner segment, outer segment, and RPE layers?"
"mewds, AZOOR, solar retinopathy, commotio retinae"
what is the most important prognostic factor for BRVO
what sickle cell traits are worst for the eye
SC and Sthal
what are the risk factors for brvo and crvo and which ones are different for them?
"HTN, glaucoma, cardiovascular disease; BRVO also morbid obesity; CRVO also DM"
what are indications for lasering lattice degeneration
"aphakic, presence of RD in other eye, presence of flap tears, high myopia"
how do you differentiate senile retinoschises from RD
"smooth domed, reacts to photocoagulation, no shifting subretinal fluid, no vit pigment/heme, absolute scotoma"
what are 2 types of retinoschises and where does split occur in each type
"1. typigcal degenerative- split occurs in outer plexiform layer; 2. reticular degenerative- split occurs in nerve fiber layer, higher chance of posterior extension"
is retinoschises assocaited with myopia or hyperopia
whats the most common cause of failure of rheg retinal detachment reppair
what is the prognosis of severe and very severe NPDR in progression to PDR
15% and 45%
what layer of the retina are exudates in the macular star of neuroretinitis
outer plexiform layer
what is ddx for bone spicules
"RP (bilateral), DUSN (unilateral), old trauma, syphilis"
what is DUSN
"subretinal spread of nematode causing poor va, multifocal choroiditis, vitritis, ON edema, bone spicules; if worm is found, treatment is laser; raccoons are carriers of nematode"
what genetic disease causes cherry red spot
tay -sachs disease
what is tay sachs disease
defect in hexosamindase A enzyme causing accumulation of ganglioside GM2 which can be deposited in brain and retina -> cherry red spot due to accumulation of abnormal protein
what is the tx for cme assocaited with RP
"diamox first, then can try subtenons or intravitreal triamcinolone"
what is ddx for dalen fuchs spots
VKH and SO
what are forster-fuchs spots
spots found in myopic degeneration; dark spots due to RPE hyperplasia in response to small CNV lesion that does not progress
what are characteristics of coat's disease
"male predominant, non-hereditary, gene found on chromosome 4, no systemic manifestations, unilateral"
fwhat are causes of angioid streaks
"PEPSI: pseudoxanthoma elasticum, ehlos danlos, sickle cell anemia, pagets disease of bone, idiopathic (and beta thalassemia)"
what are the prominent cell types involved in vitreomacular traction
what is treatment of vitreomacular traction
surgery improves VA > 2 lines in 75% of eyes; intravitreal ocriplasmin can result in resolution of traction
what test can you get to see if theres an intraocular FB in severe trauma
what are choroidal melanocytoma and how do you manage
"benign rare neoplasm immediately adjacent to ON, extremely darkly pigmented -> can very rarely undergo malignant transofrmation so you should follow with photos"
can you have birdshot without vitritis
"normal erg, abnormal EOG ALWAYS no matter the time period"
what is foveal granularity pathomneumonic for?
what week do nasal and temporal retina completely vascularize
36 and 40
what are the most common locations for scleral rupture
limbus and under insertion of rectus muscles
what abx to tx b cereus
vanc and clinda
how do you distringuish birdshot and pohs
pohs never had vitritis; birdshot always has vitritis
what is vitiliginous chorioretinitis