21. Peripheral fundus
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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
- grainy appearance
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
- veryyyy peripheral
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
- scalloped margin
What can WWOP be linked to?
- retinal tear
- high myopia
- lattice degen
- vitreous degen
What is DWOP?
- homogenous flat brown areas darker than fundi
- posterior pole
- 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?
- Multiple myeloma
How do you tell if where a lesion is located with regards to the pigment?
- choroid: grey green (through RPE filter)
- retina: black
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
- multiple lesions
ddx of FAP?
- CHRPE: unilateral discoid and solitary
- Toxo: unilateral
Peripheral blot haemorrhage?
soiltary, benign, elderly
When should you worry abt a periphal dot blot haem?
- diabetes: bilateral
- carotid artery disease: unilateral
- MS: phlebitis and female
- trauma: following event
proliferative diabetic retinopathy
hyperpigmented border due to hyperplasia, pulling of RPE
Cystic retinal tuft?
- near equator
- 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
- holes/retinal atrophy
What can follow on from a lattice degeneration?
- atrophic holes: 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
- cigar shaped
- 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
- vitrous collapse
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
- DDX: 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?
- detachment risk
- 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
- 1. spontaneous: IT, native indians
- 2. traumatic: 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
- minus undulations
Pigment demarcation lines?
if subretinal fluid remains stationary for >3m: hyperplasia of RPE at margin and demarcation will develop
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