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Retinal diseases 2 :rainbow: (:cloud:Other Retinal vascular diseasesâĶ
Retinal diseases 2 :rainbow:
:cloud:
Diabetic Retinopathy
Stages
of DR
Nonproliferative diabetic retinopathy
Mild
Moderate
Severe
Proliferative diabetic retinopathy
High risk
Complicated
Diabetic macular edema (DME)
Screening
:ice_cream:
Management
Surgery
PPV
Laser
Panphotocoagulation (PRP)
Focal laser
:star:
Anti-VEGF injection
Control underlying
Observe
:cloud:
Other Retinal vascular diseases
Hypertensive Retinopathy
Sickle cell Retinopathy
Venous occlusive disease
Branch Retinal Vein Occlusion
Central retinal vein occlusion
Ocular ischemic syndrome & Retinopathy of carotid occlusive ds
Arterial occlusive disease
Branch Retinal Artery Occlusions
Cilioretinal Artery Occlusion
Central Retinal Artery Occlusion
Vasculitis
Cystoid macular edema
Coats disease
Radiation retinopathy
:cloud:
Aged-related Macular degeneration
Non-neovascular abnormalities
Drusen
Abnormalities of RPE (retinal pigment epithelium)
Neovascular AMD
CNV (Choroidal neovascularization)
Management
Amsler Grid
Micronutrients
Anti-VEGF injection
Photodynamic therapy
Disorders of Retina & Vitreous
:rainbow:
:cloud:Non-trauma
Diabetic Retinopathy
Other Retinal vascular ds
Aged-related Macular Degeneration
Central serous chorioretinopathy
Retinopathy of prematurity
Systemic drug toxicity
Retinal detachment
Diseases of Vitreous
:rain_cloud:Trauma
Posterior segment manifestations of Trauma
:cloud:
Central Serous Chorioretinopathy (CSR)
Symptoms
Micropsia
Acute or Subacute, Central vision loss or distortion
Metamorphopsia
:arrow_down: Contrast sensitivity
Color saturation
Causes
: Hyperpermeable choroidal capillaries, Retinal pigment epithelium dysfunction
Serous Detachment of Neurosensory retina
Inx
:
OCT
seen āļĢāļāļĒāļāļđāļ
Mx
Medication
:!:
Avoid Corticosteroid
Surgical care
Focal Laser
PDT
Pt education
Avoid stressful situations
Do stress-reducing activities (eg. exercise, medication, yoga) is rec.
assoc.
with systemic hypertension with CSR
Tho it's still unknown whether careful control of systemic HT will :arrow_down: incidence of CSR
:cloud:
Retinopathy of Prematurity
(ROP)
Def
: Lack of complete or normal retinal vascularization in Premature infants
4 stages
Screening
recommendation :womans_hat:
ALL
infants with BW < 1,500g
or
GA âĪ 30 wks
Selected
infants with BW in between 1,500-2,000 g
or
GA > 30 wks with
unstable clinical course high risk
Unstable = āđāļŠāđ tube, āđāļŠāđ O2 mask
1st examination
at
4-6 wks after birth
:<3:
Note: if āļāļĢāļ§āļat 1-2 wk āļāļ°āđāļĄāđāđāļāļāđāļĢāđāļ āđāļāļĩāđāļĒāļ§āļāļąāļāļāļĩāļāļāļĩāļāđâmiss āđāļĄāđāļĒāļāļĄāļĄāļēāļāļĩāļ
:cloud:
Systemic Drug Toxicity
Chloroquine
Derivatives (rheumatoid Rx)
Mechanism: bind to Melanin in RPE
Signs
Earliest sign
Bilateral, paracentral VF changes
Bilateral atrophic bulls' eye maculopathy
Paracentral scotoma
Dose:
Hydroxychloroquine (Plaquenil)
> 6.5 mg/kg/day
Chloroquine
> 3 mg/kg/day
Phenothiazines
(Chlorpromazine, Thioridazine)
Mechanism: Binds to Melanin granules
Pigmentary retinopathy
Others
Tamoxifen
Crystalline :hourglass: retinopathy
Maculopathy
Rifabutin
Anterior & Posterior Uveitis
Digitalis
Blurred vision
Pericentral scotoma
Defective color vision
Xanthopsia (yellow vision)
Sildenafil
Transient blue tinting of vision
Temporary abnormal ERG response
100 mg per dose
:cloud:
Retinal detachment
(RD)
Retinal breaks
Posterior vitreous detachment
Types
Rhegmatogenous RD
Tractional RD
common in DM, āđāļĢāļāļāļĩāđāļĄāļĩ fibrous
Exudative RD
āļāļąāđāļ āđāļĨāđāļ§ RD āļāļ°āļŦāļēāļĒāđāļ
āļāļāļāļāļ RD āļāļ°āļāđāļāļ
:cloud:
Diseases of Vitreous
Posterior vitreous detachment
Epiretinal membrane
Vitreomacular traction syndrome
Idiopathic macular holes
Vitreous opacities
Asteroid hyalosis
Cholesterolosis (Synchysis scintillans)
Vitreous hemorrhage
:red_circle:
found in
Proliferative diabetic retinopathy (PDR)
Vitreous detachment with or without retinal break
Vascular occlusive ds
causes in Thailand
Proliferative diabetic retinopathy (PDR)
Retinal vein occlusion
Age-related Macular degeneration
Vitreous detachment with or without retinal breaks
:rain_cloud:
Posterior segment manifestations of Trauma
Blunt
trauma
Hyphema
Vitreous hemorrhage
Angle recession
Retinal tear or detachment
Lens subluxation or dislocation
Commotio retinae
Choroidal rupture
Macular hole
Penetrating
trauma (āļāļēāđāļāļĩāļĒāļ§āđāļāđāļē)
Perforating
Trauma (āđāļāđāļēāđāļĨāđāļ§āļāļāļāļāđāļ§āļĒ)
Intraocular FB
Posttraumatic endophthalmitis
Systemic ophthalmia