21. Peripheral fundus
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21. Peripheral fundus
Vortex ampulla varix?
fill with fluid during indentation
can just ask px to look in a diff direction
What is peripheral cystoid degeneration is it dangerous and how does it appear in the retina?
ubiquitous from young age and benign
development of cystoid cavities
What is a meridional fold?
raised bands of tissue running across the peripheral retina
ocassional small hole at base
What is significant about the hole at the base of a meridional fold?
enclosed oral bay
mistaken for retinal hole
What are oral pearls?
white lesions on a dentate process
similar to drusen
What is reticular pigment degeneration?
common with ageing, caucasian, benign
equatorial migration of pigment up to sensory retina
focal chorioretinal atrophy?
seen in young px
loss of RPE/choriocapillaris and thinning of overlying sensory retina
can see down to the sclear
hyperpigmentation at edges
What is pavingstone's degeneration?
multiple focal chorioretinal atrophies that aggregate and coalesce
increased pigmentation dispersed throughout the lesion
wont affect VA too peripheral
RPE window defect?
similar to pavingstone's but larger and creamier
no loss of tissue
: RPE has become depigmented
becomes larger with age
hyperpigmentation at margins
what is WWOP?
unusual vitreoretinal relationship where the NFL has become disorganised
seen in myopes and plp with dark fundi
what can WWOP look like?
hazy white sheen with indistinct margin
demarcated borders- high risk of retinal tear along this border
What can WWOP be linked to?
What is DWOP?
homogenous flat brown areas darker than fundi
if seen in caucasians- sickle cell disease
What does a pars plana cyst look like?
smooth ovoid elevation
grape/finger like structure
What are pars plana cysts linked with?
How do you tell if where a lesion is located with regards to the pigment?
: grey green (through RPE filter)
CHRPE whereabouts and appearance?
solitary, margins are depigmented looks like its floating on the retina, benign
ddx of CHRPE?
toxo scar: except upon inspection, well circumscribed edges
What is Familial Adenomatous Polyps?
has multiple polyps that develop into melanomas
fatal by 35 years
What does FAP look like in the fundus?
pigmented ovoid RPE lesions with a depigmented tail
ddx of FAP?
: unilateral discoid and solitary
Peripheral blot haemorrhage?
soiltary, benign, elderly
When should you worry abt a periphal dot blot haem?
carotid artery disease
: phlebitis and female
: following event
proliferative diabetic retinopathy
hyperpigmented border due to hyperplasia, pulling of RPE
Cystic retinal tuft?
grey structures overlying retina
area of increase vitreoretinal traction
What to note abt tufts?
dont need to do anything about these
maybe a site for retinal tear
Lattice degeneration facts?
atrophic peripheral retina in lattic pattern and may develop tears/breaks/holes
found in 20-40% eyes with RRD
evident in 20s
increased prevalence myopes
Lattice degeneration features?
lattice runs parallel to ora
may/may not have hyperpigmentation/hyaluronisation of vessels
area of retina has thinned
What may the retinal thinning in lattice degeneration cause?
lacuna- pocket of liquefaction overlying lattice lesion
vitreous along edges of lattice lesion adheres to retina
ischaemia and thinning will disturb RPE-> RPE hyperplasia and pigmentary changes
What can follow on from a lattice degeneration?
: adjacent or within
fluid between sensory retina and RPE
What is a snailtrack degeneration?
sharply demarcated bands of tightly packed ‘snowflakes’ which give the peripheral retina a white frost-like appearance
higher risk of RT or RB
Review for lattice+ atrophic holes, lattice + retinal tears?
What is synchisis?
vitreous liquefication: collagen free liquid filled spaces
What is syneresis?
exudation of liquid from vitreous gel as collagens, other molecules clump/aggregate
PP glial tissue that reminas attached to posterior vitreous cortex after a detachment
What normally keeps the retina in place?
Matrix/proteoglycans between PR and RPE
interdigitation of PR and RPE
RPE pumping ions and fluid across the retina-> choroid
What is a posterior hyaloid
seen after PVD
seen behind the lens hanging from the superior vitreous base
: prepapillary vascular loop
PVD at site of vessels ruptures it
IMPORTANT FOR PVD!
pigment granules immediately behind the crystalline lens from RPE migrating anteriorly
What is the cause behind an atrophic retinal hole?
loss of sensory retinal due to nutritonal deprivation and inadequate supply from choriocapillaris
RD risk low
What are floaters?
things in VF
more common in myope, diabetes, post cataract
What can a sudden increase in floaters and flashes + VA loss mean?
What is an operculated retinal tear?
when vitreous contract and pulls away from retina, rips piece of it out
worry abt ORT?
not much since youve ripped retina out
Linear flap tear?
persistent tracion on flap which opens subretinal space to let liquified vitreous in
worry abt Linear tear?
high rish of RD
refer for laser
What is retinal dialysis? 2 types?
separation of sensory retina at the ora
semicircular shaped, red/brown break
: IT, native indians
: SN, blunt trauma
puckering of macula due to peripheral retinal tear
RPE cells (schafers) drop down onto retina to cause proliferation
Tx for lattice+tear?
is RB is large
Long standing detachment?
becomes atrophic and contracts
Pigment demarcation lines?
if subretinal fluid remains stationary for >3m: hyperplasia of RPE at margin and demarcation will develop