-
What is a degenerative retinoschsis and what causes it?
- split of retina at the OPL found in the peripheral retina due to coalescing of cystoid spaces
- creating outer and inner holes
- will produce VF defects
- found mostly in periphery
-
Degenerative retinoschisis?
- bilateral
- 1st appears in infero-temporal quadrant
- slowly progressive with age
- asymptomatic
-
What are the types of degenerative retinoschisis and where is it found?
bulbous visible vs non visible flat
-
bullous Degen retino cf RD?
doesnt undulate/wobble
-
How does liquefaction of the vitreous occur and how can it lead to a PVD?
- pockets of liquid appear within central vit and coalesce
- weakensing of VR adhesion
- liquid vit dissects gel away from ILM of the retina-> PVD
-
How is a retinal horseshoe tear formed?
- incomplete PVD- traction of the retina
- vitreous pulls away from sensory retina but remains attached to one end of the tear while the base is at the retina
-
What are sx of RB?
- floaters
- photopsia
- blurry va
-
What are signs of RB?
- atrophic holes
- operculated tears
- linear tears
- retinal dialysis
-
how is RD associated with PVD?
- RRD-> acute PVD
- TRD-> incomplete PVD
- serous/exudative NOT REALTED TO PVD
-
risk of RD with retinoschisis?
low as hard for liquefying vitreous to get through the lesion
-
What are some acute PVD sx?
- floaters
- photopsia
- blurry vision
- metamorphopsia
-
Signs of acute PVD?
- weiss ring
- disc haem
- vit haem
- shafers
-
DDX for photopsia VR traction?
PVD, optic neuritis, migraine, hypotension, TIA
-
DDX for floaters?
PVD, PDR, uveitis
-
DDX for VF loss- peripheral detachment?
OPtic neuropathy CVA BRVO BRAO
-
Sx of RD?
- photopsia
- floaters
- weiss
- schaffers
- VF loss- black curtain
- decreased VA
- RAPD
- IOP changes
- retinal appearance: grey/opaque, balloning tears
-
Risk factors for RD?
aging, cataract surgury, focal retinal atrophy, myopia, trauma
-
What is the most common type of RD?
RRD
-
RRD facts?
- most common form of RD
- 40-80yo
-
How does an RRD occur?
- fluid from vitreous cavity passes through retina defect into subretinal space and separates neural retina from RPE
- retinal break + vitreous liquefication + traction
-
What can predispose a retinal break?
- lattice degeneration
- snail track degen
- peripheral cystoid degeneration
- retinoschisis
- retinal tuft
-
How urgent is a RD?
- if macula on detachment: urgent
- if not on: few days
-
Most common site of tear?
superotemporal>superonasal,inferiortemporal> inferonasal
-
What is a tractional retinal detachment caused by?
- fibrotic/fibrovascular membranes in vit (assoc with inflam exudates + vit haem) creating a retinal traction
- PVR, ROP, trauma, cataract, post uveitis
-
What are some features of TRD?
- concave and no breaks
- retinal mobility is reduced
- photopsia+floaters absent
- VF defect slow prog
-
What is dynamic traction?
-
What is a static traction?
- indep of eye movement
- TDR and PVR
-
What is Proliferative Vitreoretinopathy?
- wound healing process
- prolif of avascular retinal membranes assoc with RRD
- contraction of membranes-> macula pucker-> new RB/RD and ocular hypotony
-
What is a combined RTRD?
- combination of retinal break+traction
- 2ndy to traction
- PVR
-
Therapeutic retinal detachment
- rare
- OAG miotics cause intense miosis leading to retinal stretching in high myopic eyes -> RT
-
What is a serous/exudative/2ndy RD?
elevation of neural retina due to accumulation of subretinal fluid in ABSENCE of a retinal break or sig preretinal traction
-
What are some key features of a serous/exudative RD?
- subretinal fluid shifts with head position
- lack of RRD/TRD
- 2ndy to local ocular/systemic etiology
-
How can subretinal fluid accummulate?
- increase in fluid flow in subret space: leaky vessels in tumour
- impaired outflows: choroidal inflam
- outer BRB breakdown + impairment of RPE pump: CSCR
-
Signs of serous RD?
- convex smooth elevation
- mobile deep and shifting fluid
- leopard spots: subret pigment
-
Uveal effusion?
- fluid escapes from vessels into body tissue/space
- transudative fluid from choriocap
- thickening of choroid/choroid detachment
-
UES?
- uveal effusion (-)inflammation, surgery, hypot
- idiopathic?
- abnormal scleral collagen
- vortex vein compression
-
RD prophylactic tx?
- laser photocoagulation
- cryotherapy
- laser/scleral indentation
-
RD tx?
- scleral buckling
- pneumatic retinopexy: gas bubble, seal break/reattach retina
- cryotherapy: scar-fusion of RPE and retina
-
Pars plana vitrectomy?
- remove vitreal opacities/vitreous: decrease of other RB
- release VR traction
-
-
RT position?
above midline progress to RD faster than below
|
|
