16. Acquired Retinal Dystrophies

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sookylala
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246485
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16. Acquired Retinal Dystrophies
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2013-11-12 04:55:38
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Acquired Retinal Dystrophies
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Acquired Retinal Dystrophies
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  1. risk factors for AMD?
    family, age, hypertension, smoking, caucasian, diet-obesity and fat
  2. What is dry AMD?
    atrophic, non exudative, more common
  3. Presentation of dry AMD?
    gradual loss of vision, bi, asym
  4. What are the signs of dry AMD?
    • geographical atrophy: choroidal vessels visible
    • soft drusen-confluent
    • focal hypo/hyper pig of RPE
    • drusenoid RPE detachment
  5. treatment for dry amd?
    • AREDS
    • AREDS2: (-) beta caratine (t) lutein and zeaxanthin
  6. What is wet AMD?
    • less common but more insidious
    • neovascular->haem, RPE detachments, retinal scarring and hard exudates
  7. 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
  8. 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
  9. What is Polypoidal choroidal vasculopathy?
    • dilated network of inner choroidal vessels
    • multiple terminal aneurysmal protuberances
  10. Who are affected by PCV?
    japan, caucasians, 50-60, uni/bu/asy
  11. 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
  12. DDX PCV?
    • wet AMD, progress faster, VA more affected
    • both have: sub ret haem, RPE atrophy, PED
    • (+)polypoidal lesions, choriodal vessel network
    • (-) CNV and drusen
  13. Diagnosis of PCV?
    • OCT: abnorm surrounding poly
    • ICGA: network of choroidal vessels
    • polyp swelling= leakage
    • hypo-> hyper
  14. Tx of PCV?
    • PDT+avastin/lucentis
    • decreased PED
    • fluid absorption
    • Va improvement
  15. Central serous choroiretinopathy?
    serous detachment at macula 2ndy to leakage from choriocap from RPE defects
  16. Presentation of CSCR?
    • uni metamorph
    • VA better- bulging macula= hyperopic
  17. Signs of CSCR?
    • oval/round detachment at macula
    • subretinal fluid: clear, turbid, fibrous+precipitates
    • abnorm depig RPE: small PED
    • RPE atrophy
  18. Tests for CSCR?
    • Amsler: metamorp
    • OCT: elevation¬†
    • FA: smokestack, inkblot
  19. Prognosis of CSCR?
    spontaneous regression ~ months
  20. Macula holes?
    • 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
  21. cystoid macula edema?
    • accumulation of fluid in OPL ILM- cysts
    • longterm: cyst spaces coalesce-> lamellar hole
    • diabetes
    • OD swelling, lamellar hole, foveal depression, retinal thickening, multiple cystoid areas
  22. Epiretinal membrane?
    • sheetlike vribrocellular structure on retina
    • glial
    • proliferation+contraction +/- CMO
    • 2ndy: RD surgery, tears/breaks
  23. Angioid streaks?
    bi, cracks in thickended/calcified bruch's membrane
  24. Appearance of angioid streaks?
    • orange mottled pigmentation
    • grey/red linera lesions w serrated edges
  25. 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
  26. choroidal folds
    • horizontal parallel grooves/striae across the post pol due to compression
    • cause: idiopathic, papilledema, orbital tumour

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