21. Peripheral fundus

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21. Peripheral fundus
2013-11-13 08:02:18
peripheral fundus

peripheral fundus
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  1. Vortex ampulla varix?
    • fill with fluid during indentation
    • can just ask px to look in a diff direction
  2. 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
    • grainy appearance
  3. What is a meridional fold?
    • raised bands of tissue running across the peripheral retina
    • ocassional small hole at base
  4. What is significant about the hole at the base of a meridional fold?
    • enclosed oral bay
    • mistaken for retinal hole
  5. What are oral pearls?
    • white lesions on a dentate process
    • similar to drusen
    • veryyyy peripheral
  6. What is reticular pigment degeneration?
    • common with ageing, caucasian, benign
    • equatorial migration of pigment up to sensory retina
  7. Equatorial drusen?
  8. 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
  9. What is pavingstone's degeneration?
    • multiple focal chorioretinal atrophies that aggregate and coalesce
    • increased pigmentation dispersed throughout the lesion
    • ageing
    • wont affect VA too peripheral
  10. 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
  11. what is WWOP?
    • unusual vitreoretinal relationship where the NFL has become disorganised
    • seen in myopes and plp with dark fundi
  12. what can WWOP look like?
    • hazy white sheen with indistinct margin
    • demarcated borders- high risk of retinal tear along this border
    • scalloped margin
  13. What can WWOP be linked to?
    • retinal tear
    • high myopia
    • lattice degen
    • vitreous degen
  14. What is DWOP?
    • homogenous flat brown areas darker than fundi
    • posterior pole
    • if seen in caucasians- sickle cell disease
  15. What does a pars plana cyst look like?
    • smooth ovoid elevation
    • grape/finger like structure
  16. What are pars plana cysts linked with?
    • idiopathic
    • RD
    • uveitis
    • Multiple myeloma
  17. How do you tell if where a lesion is located with regards to the pigment?
    • choroid: grey green (through RPE filter)
    • retina: black
  18. CHRPE whereabouts and appearance?
    • >equator
    • solitary, margins are depigmented looks like its floating on the retina, benign
  19. ddx of CHRPE?
    toxo scar: except upon inspection, well circumscribed edges
  20. What is Familial Adenomatous Polyps?
    • has multiple polyps that develop into melanomas
    • fatal by 35 years
  21. What does FAP look like in the fundus?
    • pigmented ovoid RPE lesions with a depigmented tail
    • multiple lesions
  22. ddx of FAP?
    • CHRPE: unilateral discoid and solitary
    • Toxo: unilateral
  23. Peripheral blot haemorrhage?
    soiltary, benign, elderly
  24. When should you worry abt a periphal dot blot haem?
    • diabetes: bilateral
    • carotid artery disease: unilateral
    • MS: phlebitis and female
    • trauma: following event
  25. Peripheral NV
    proliferative diabetic retinopathy
  26. Retinal tuft?
    hyperpigmented border due to hyperplasia, pulling of RPE
  27. Cystic retinal tuft?
    • near equator
    • grey structures overlying retina
    • area of increase vitreoretinal traction
  28. What to note abt tufts?
    • record
    • dont need to do anything about these
    • maybe a site for retinal tear
  29. Lattice degeneration facts?
    • atrophic peripheral retina in lattic pattern and may develop tears/breaks/holes
    • found in 20-40% eyes with RRD
    • bilateral
    • evident in 20s
    • increased prevalence myopes
  30. Lattice degeneration features?
    • lattice runs parallel to ora
    • may/may not have hyperpigmentation/hyaluronisation of vessels
    • area of retina has thinned
  31. 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
    • holes/retinal atrophy
  32. What can follow on from a lattice degeneration?
    • atrophic holes: adjacent or within
    • fluid between sensory retina and RPE
  33. What is a snailtrack degeneration?
    • sharply demarcated bands of tightly packed ‘snowflakes’ which give the peripheral retina a white frost-like appearance
    • cigar shaped
    • higher risk of RT or RB
  34. Review for lattice+ atrophic holes, lattice + retinal tears?
    • 6-12m referral
    • immediate
  35. What is synchisis?
    vitreous liquefication: collagen free liquid filled spaces
  36. What is syneresis?
    • exudation of liquid from vitreous gel as collagens, other molecules clump/aggregate
    • vitrous collapse
  37. Weiss's ring?
    PP glial tissue that reminas attached to posterior vitreous cortex after a detachment
  38. What normally keeps the retina in place?
    • IOP
    • Matrix/proteoglycans between PR and RPE
    • interdigitation of PR and RPE
    • RPE pumping ions and fluid across the retina-> choroid
  39. What is a posterior hyaloid
    • seen after PVD
    • seen behind the lens hanging from the superior vitreous base
    • DDX: prepapillary vascular loop
  40. vitreous haem?
    PVD at site of vessels ruptures it
  41. Schafers sign
    • pigment granules immediately behind the crystalline lens from RPE migrating anteriorly
  42. 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
  43. What are floaters?
    • things in VF
    • more common in myope, diabetes, post cataract
  44. What can a sudden increase in floaters and flashes + VA loss mean?
  45. What is an operculated retinal tear?
    when vitreous contract and pulls away from retina, rips piece of it out
  46. worry abt ORT?
    • detachment risk
    • not much since youve ripped retina out
  47. Linear flap tear?
    • dangerous
    • persistent tracion on flap which opens subretinal space to let liquified vitreous in
  48. worry abt Linear tear?
    • yes!
    • high rish of RD
    • refer for laser
  49. What is retinal dialysis? 2 types?
    • separation of sensory retina at the ora
    • semicircular shaped, red/brown break
    • 1. spontaneous: IT, native indians
    • 2. traumatic: SN, blunt trauma
  50. ERM?
    • puckering of macula due to peripheral retinal tear
    • RPE cells (schafers) drop down onto retina to cause proliferation
  51. Tx for lattice+tear?
    laser photocoagulation
  52. Cryotherapy?
    is RB is large
  53. Long standing detachment?
    • becomes atrophic and contracts
    • minus undulations
  54. Pigment demarcation lines?
    if subretinal fluid remains stationary for >3m: hyperplasia of RPE at margin and demarcation will develop