AMD:
people over 55 and leading cost of irreversible blindness in developed country.
Etiology: sclerosis of arteries that nourish retina
Types: Exudative or Wet and Non-Exudative or dry
Symptoms: Diminution of vision & metamorphosia
Signs: Drusen of Bruch's Membrane and Generalized pigmentary granularity
Treatment:
Wet: Photocogulation of choriodal neovascular membrane & anti VEGF therapy .
Dry: Anti-oxidatants
aviod smoking
Myopic Macular Degeneration
characteristic fundoscopic finding: Lacquer Crack i.e. peripapillary chorioretinal atrophy and breaks in bruch's membrance
characteristics funding: raised circular fuch's spot
Diagnosis: Fluorescien Angiography shows delayed filling of choriocapillaries
Treatment: anti-VEGF
Diabetics Retinopathy
Non Proliferative Retinopathy
1. Mild: a few microaneurysms, RH and hard exudates seen in atleast two quadrants
2.Moderate: above finding in two quadrants
3. Severe: In all quadrants with atleast one of following three signs (cotton wool spot, irregular venous calibre & IRMA)
4. Very severe: same as above with two of above mention three signs
Proliferative Retinopathy
Early or without risk: retinal neovascularisation not at disk but else where.
Late or Risk: Retinal neovascularisation at disk with or without viterous haemorrages & NVE with viterous haemorrages
Maculopathy
CSME
Non-CSME
they are of four types of diabetic maculopathy a/c to fluroscein angiographically
1.Focal 2.Diffuse 3. Ischemic 4. Mixed
Advanced Diabetic Eye Disease
Uncontrolled proliferative Retinopathy
Daignosis:
OCT for macular edema
Fluroscien Angiography: neovascularisation
Treatment:
Control Diabetics, Hyperglycemia, Hypercholestrolemia
Maculopathy
focal---focal photocoagulation
Diffuse---Grid Laser
Proliferative Retinopathy: Panretinal Photocoagulation (NVE/NVD)
Advanced Diabetic Disease: Viteroretinal Surgery with photocoagulation (Viterous Haemorrhage/Tractional retinal detachment)
Retinoblastoma:
common in age group 2-,autosomal dominant, unilateral but in 25% bilateral, neurosensory epithelim
1. Poorly Differentiated--resembles nuclear layer of retina
2. Well Differentiated Tumor
Rosettes--a) Flexner-Wintersteiner Rosettes b) Homer Wright Rosettes c) Pseudorosettes
Fleurettes
Symptoms:
1) Leucoria 2) Convergent Squint 3) pain 4)nystagmus bilateral 5) Enlargment of globe
Types:
Glioma Exophytum & Glioma Endophytum
Stages:
1. Quiescent Stage 2. Glaucomatous Stage 3. Extraocular Extension 4. Metastasis
D/D
Congential Cataract, Pseudoglioma, Tb of Choroid, Toxocora, Retinolental fibroplasia
Diagnosis:
Raised I/O pressure
raised lactic Dehydrogenase & Phosphoglucose Isomerase
Plain X-ray shows calcification in 75%
CT scan & MRI
Treatment:
Ennucleation (stage 1 & 2)
Extenteration of Orbit (stage 3)
Radiation & Chemotherapy (4000 rads & than supplemented with Vincristine and Cyclophosphamide)
Cyrotherapy
photocoagulation by argon laser for less than 3mm
Retinal Vein Occulsion
scattered retinal hemorrhagic & Cotton Wool appearance
Risk Factor: patient over 50 & more than 50% have CVS
Major Complications:
1. Macular Edema 2. Iris and Retinal NV
Macular Edema:
Macular Edema due to central rentinal vein doesn't response to Laser. In branch retinal vein occulsion use grid focal argon laser
Iris NV:
PRP.
Retinal Artery Occulsion
transisent lose of vision
Central Vision preserved due to cilioretinal blood flow
Cherry red spot: at fovea
Treatment:
Anterior Chamber paracentesis & IV acetazolamide (to decrease IOP)
Inhaled Oxygen & Carbon Dioxide Mixture (vasodilation)
Retinopathy of Prematurity
1-Demaracation Line
2. Intraretinal Ridge
3. Ridge with extraretinal Fibrovascular Proliferation
4. Subtotal retinal Detachment
5. Total Retinal Detachment
Peripheral Retinal Laser: stage 2
Viteroretinal Surgery: Stage 4 & Stage 5
Retinal Detachment
Separation of Sensory retina & retinal pigment epithelium
Three Main types:
Rhgematogenous Retinal Detachment
full thickness break associated with myopia. lattice degeneration, aphakia, trauma
horse shoe--superotemporal
atropic-temporal
retinal dialysis--inferotemporal
Treatment: Pneumatic Retinopathy, Scleral Buckling & Pars plana vitrectomy
Traction Retinal Detachment:
1. Proliferative DM, vitreoretinoathy, ROP or trauma
Serous & Hemorrhagic Retinal Detachment
Infectious, Inflammatory & Degenerative Disease
Retinitis Pigmentosa
Hereditary disorder characterized by progressive dysfunction of photoreceptor, associated with progressive cell loss and eventual atropy of several retinal layers.
Symptoms
Night Blindness & Gradually increasing peripheral visual loss
Fundoscoping findings: attenuted retinal arterioles, waxy pale optic disk, peripheral retinal pigment clumping "bone spicule formation"
people over 55 and leading cost of irreversible blindness in developed country.
Etiology: sclerosis of arteries that nourish retina
Types: Exudative or Wet and Non-Exudative or dry
Symptoms: Diminution of vision & metamorphosia
Signs: Drusen of Bruch's Membrane and Generalized pigmentary granularity
Treatment:
Wet: Photocogulation of choriodal neovascular membrane & anti VEGF therapy .
Dry: Anti-oxidatants
aviod smoking
Myopic Macular Degeneration
characteristic fundoscopic finding: Lacquer Crack i.e. peripapillary chorioretinal atrophy and breaks in bruch's membrance
characteristics funding: raised circular fuch's spot
Diagnosis: Fluorescien Angiography shows delayed filling of choriocapillaries
Treatment: anti-VEGF
Diabetics Retinopathy
Non Proliferative Retinopathy
1. Mild: a few microaneurysms, RH and hard exudates seen in atleast two quadrants
2.Moderate: above finding in two quadrants
3. Severe: In all quadrants with atleast one of following three signs (cotton wool spot, irregular venous calibre & IRMA)
4. Very severe: same as above with two of above mention three signs
Proliferative Retinopathy
Early or without risk: retinal neovascularisation not at disk but else where.
Late or Risk: Retinal neovascularisation at disk with or without viterous haemorrages & NVE with viterous haemorrages
Maculopathy
CSME
Non-CSME
they are of four types of diabetic maculopathy a/c to fluroscein angiographically
1.Focal 2.Diffuse 3. Ischemic 4. Mixed
Advanced Diabetic Eye Disease
Uncontrolled proliferative Retinopathy
Daignosis:
OCT for macular edema
Fluroscien Angiography: neovascularisation
Treatment:
Control Diabetics, Hyperglycemia, Hypercholestrolemia
Maculopathy
focal---focal photocoagulation
Diffuse---Grid Laser
Proliferative Retinopathy: Panretinal Photocoagulation (NVE/NVD)
Advanced Diabetic Disease: Viteroretinal Surgery with photocoagulation (Viterous Haemorrhage/Tractional retinal detachment)
Retinoblastoma:
common in age group 2-,autosomal dominant, unilateral but in 25% bilateral, neurosensory epithelim
1. Poorly Differentiated--resembles nuclear layer of retina
2. Well Differentiated Tumor
Rosettes--a) Flexner-Wintersteiner Rosettes b) Homer Wright Rosettes c) Pseudorosettes
Fleurettes
Symptoms:
1) Leucoria 2) Convergent Squint 3) pain 4)nystagmus bilateral 5) Enlargment of globe
Types:
Glioma Exophytum & Glioma Endophytum
Stages:
1. Quiescent Stage 2. Glaucomatous Stage 3. Extraocular Extension 4. Metastasis
D/D
Congential Cataract, Pseudoglioma, Tb of Choroid, Toxocora, Retinolental fibroplasia
Diagnosis:
Raised I/O pressure
raised lactic Dehydrogenase & Phosphoglucose Isomerase
Plain X-ray shows calcification in 75%
CT scan & MRI
Treatment:
Ennucleation (stage 1 & 2)
Extenteration of Orbit (stage 3)
Radiation & Chemotherapy (4000 rads & than supplemented with Vincristine and Cyclophosphamide)
Cyrotherapy
photocoagulation by argon laser for less than 3mm
Retinal Vein Occulsion
scattered retinal hemorrhagic & Cotton Wool appearance
Risk Factor: patient over 50 & more than 50% have CVS
Major Complications:
1. Macular Edema 2. Iris and Retinal NV
Macular Edema:
Macular Edema due to central rentinal vein doesn't response to Laser. In branch retinal vein occulsion use grid focal argon laser
Iris NV:
PRP.
Retinal Artery Occulsion
transisent lose of vision
Central Vision preserved due to cilioretinal blood flow
Cherry red spot: at fovea
Treatment:
Anterior Chamber paracentesis & IV acetazolamide (to decrease IOP)
Inhaled Oxygen & Carbon Dioxide Mixture (vasodilation)
Retinopathy of Prematurity
1-Demaracation Line
2. Intraretinal Ridge
3. Ridge with extraretinal Fibrovascular Proliferation
4. Subtotal retinal Detachment
5. Total Retinal Detachment
Peripheral Retinal Laser: stage 2
Viteroretinal Surgery: Stage 4 & Stage 5
Retinal Detachment
Separation of Sensory retina & retinal pigment epithelium
Three Main types:
Rhgematogenous Retinal Detachment
full thickness break associated with myopia. lattice degeneration, aphakia, trauma
horse shoe--superotemporal
atropic-temporal
retinal dialysis--inferotemporal
Treatment: Pneumatic Retinopathy, Scleral Buckling & Pars plana vitrectomy
Traction Retinal Detachment:
1. Proliferative DM, vitreoretinoathy, ROP or trauma
Serous & Hemorrhagic Retinal Detachment
Infectious, Inflammatory & Degenerative Disease
Retinitis Pigmentosa
Hereditary disorder characterized by progressive dysfunction of photoreceptor, associated with progressive cell loss and eventual atropy of several retinal layers.
Symptoms
Night Blindness & Gradually increasing peripheral visual loss
Fundoscoping findings: attenuted retinal arterioles, waxy pale optic disk, peripheral retinal pigment clumping "bone spicule formation"
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