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risk factors for AMD?
family, age, hypertension, smoking, caucasian, diet-obesity and fat
What is dry AMD?
atrophic, non exudative, more common
Presentation of dry AMD?
gradual loss of vision, bi, asym
What are the signs of dry AMD?
- geographical atrophy: choroidal vessels visible
- soft drusen-confluent
- focal hypo/hyper pig of RPE
- drusenoid RPE detachment
treatment for dry amd?
- AREDS2: (-) beta caratine (t) lutein and zeaxanthin
What is wet AMD?
- less common but more insidious
- neovascular->haem, RPE detachments, retinal scarring and hard exudates
What are the signs of wet AMD?
- blurry VA, metamorphopsia
- 1: RPE detachment, PED
- 2: new vessels: subretinal and choroidal
- 3: haem: sub retinal
- 4: scar: resolved haem, fibrovascular tissue
- 5: soft+hard drusen
What are some treatments for wet AMD?
- antiVEGF: hypoxia-> VEGF-> VEGF-R-> NV-leak
- avastin and lucentis: inactivates VEGF
- Eyelea: binds to VEGF so it can't bind to VEGF-R
- Laser photocoagulation: blast NV
- PDT: injection of drug-> laser eye where drug is- binds vessels and stops growth
- Steroids: reduces leakage, inflammation, MO
- SE: non response and PSC
What is Polypoidal choroidal vasculopathy?
- dilated network of inner choroidal vessels
- multiple terminal aneurysmal protuberances
Who are affected by PCV?
japan, caucasians, 50-60, uni/bu/asy
What are the signs of PCV?
- polypoidal lesions: red orange round aneurysms at end of branching vessels
- detachment of RPE/retina around ON/macula
- subretinal haem
- RPE atrophy
- branching network of choroidal bv
- mutliple PEDs
- wet AMD, progress faster, VA more affected
- both have: sub ret haem, RPE atrophy, PED
- (+)polypoidal lesions, choriodal vessel network
- (-) CNV and drusen
Diagnosis of PCV?
- OCT: abnorm surrounding poly
- ICGA: network of choroidal vessels
- polyp swelling= leakage
- hypo-> hyper
Tx of PCV?
- decreased PED
- fluid absorption
- Va improvement
Central serous choroiretinopathy?
serous detachment at macula 2ndy to leakage from choriocap from RPE defects
Presentation of CSCR?
- uni metamorph
- VA better- bulging macula= hyperopic
Signs of CSCR?
- oval/round detachment at macula
- subretinal fluid: clear, turbid, fibrous+precipitates
- abnorm depig RPE: small PED
- RPE atrophy
Tests for CSCR?
- Amsler: metamorp
- OCT: elevation
- FA: smokestack, inkblot
Prognosis of CSCR?
spontaneous regression ~ months
- presents with vision loss uni
- 1. yellow spot flattening at macula-metamorph/VA
- 2. small full thickness hole
- 3: large full thickness hole- red base+yellow dots+ operculum
- 4: hole+PVD
cystoid macula edema?
- accumulation of fluid in OPL ILM- cysts
- longterm: cyst spaces coalesce-> lamellar hole
- OD swelling, lamellar hole, foveal depression, retinal thickening, multiple cystoid areas
- sheetlike vribrocellular structure on retina
- proliferation+contraction +/- CMO
- 2ndy: RD surgery, tears/breaks
bi, cracks in thickended/calcified bruch's membrane
Appearance of angioid streaks?
- orange mottled pigmentation
- grey/red linera lesions w serrated edges
complications/assoc angiod streaks?
- CNV, choroidal rupture, foveal involvement
- Pseudoxanthoma elasticum: hereditary disorder of connective tissue in which there is progressive calcification, fragmentation and degeneration of elastic fibres in the skin, eye and cardiovascular system
- horizontal parallel grooves/striae across the post pol due to compression
- cause: idiopathic, papilledema, orbital tumour