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Age related macular degeneration (ARMD)
- Dry (Geographic RPE atrophy)
- 15% by age 80
- 90% of ARM
- Wet ARM
- #1 cause of blindness above age 60
- Choroidal - Gray - green net of neovascularization
- Exudative - Hard exudates
- Hemorrhagic - Fibrotic
- Disciform
Cystoid macular edema (CME)
- Secondary to post - cataract surgery, radial-k, YAG laser, carotid
disease
- 6 week post-op cataract
- 50% recover in 6 months after cataract surgery
- 20% have condition for up to 5 yrs
- Loss of foveal reflex only sign - do fluroscein
- On fluroscein see flower shape in henles layer
- Steroids may help?
- Slightly reduced visual acuity and metamorphopsia
- 50% chance of developing into a hole
Idiopathic central serous choriodopathy (ICSC)
- Age 20 - 60 male
- Transient episodes of serous retinal or RPE detachments
- RPE tight attachment to Bruchs seals choroid
- Compromised RPE leads to seepage resulting in sensory retinal detachment
- Further compromise results in RPE separation from Bruchs
- End result is a retinal pigment epithiel detachment
- Loss of foveal reflex and dome forms over fovea
- Long standing shows yellow precipates in dome
- Detached RPE below detached retina seen as yellow “Lemon-drop
nodule”
- Associated with stress
- Usual recovery to 20/40 in 1-6 months
- 60% recover 20/20
- Some need photocoagulation
Inflammatory maculopathies
- Fever
- Fatigue
- Thrush
- Diarrhea
- Cotton wool
- Hemorrhages
- Cytomegalovirus CMV
- Toxoplasmosis
- Kaposi’s sarcoma
- Reddish - purple tumor near medial canthus or inferior cul-de-sac
Presumed ocular histoplasmosis POHS
- Fungus is inhaled
- Age 20-50
- Rare in blacks
- Both sexes but more often bilateral in males
- Sequence can take 2 years to end
- Peripheral lesions
- Circumpapillary chorioretinis
- Yellowish choroiditis in macula
- Pigment ring surrounding a serous detachment
- Hemorrhages (Red or gray - green)
- Exudates
- White disciform retinal detachment - 2 years
- Asymptomatic until macula attacked
- Photocoagulate and steroid’s
Sarcoidosis
- 20-60 yrs old
- 50% have ocular involvement
- Blacks more than whites
- Lung changes seen on x-ray
- Granulomatous anterior uveitis
- Periphlebitis
- Focal choroidal granulomas
- Diagnosis by lab test
Toxocara canis
-
- Age 2-40
- Dirt eaters
- Produce all types of inflammatory responses
- Visceral toxocara
- Cough, fever, abdominal pain, eruptions on legs
Ocular toxocara
- Round, raised, white lesion 1 DD in size
Toxoplasmosis
Congenital
- 80% develop retinitis
- 65% of females
- Occurs only if primary maternal infection when pregnant
- Cats are primary vector
Acquired
- Less than 1% with toxoplasmosis develop retinitis
- AIDS
General
- Cysts
- #1 cause of retinal infection
- When active posterior and anterior uveitis
- White lesion next to pigment with vitreous haze
Pre-retinal membrane
- Age 50+ or post retinal detachment surgery
- Metamorphopsia most common complaint
- Grade 0
- Cellophane maculopathy - transparent membrane
- Grade 1
- Transparent membrane above retinal folds
- Hemorrhages and localized serous detachments
Macular holes
Full thickness hole
- 1/4 - 1/3 DD reddish area with a surround of a grayish retinal
elevation like a doughnut
- May have yellow dots in hole
- Markedly reduced visual acuity and metamorphopsia
- 60 yrs +
- PVD often a cause
- Post PVD eye not at risk
- 30% develop holes in other eye
- 80% risk if pigment changes in other macula
Lamellar hole
- Cyst rupture
- Slight redness and may have a surround of preretinal membrane
- Slightly reduced visual acuity and metamorphopsia
Solar maculopathy
- Looks like a hole but is smaller
- Visual acuity is 20/25 - 20/80
Pigment epithelial detachment
- Common with age related macular degeneration
- Sharply demarcated oval or round dome
- In young as central serous retinopathy
- If overlying sensory retina detaches neovascularization may result
-
Pigment epitheliopathies
- Acute post. multiple placoid pigment epilitheliopathy
- Age 20-40 both sexes
- Sudden appearance of dirty yellow-white multipleplacoid lesions
in posterior pole
- Rapid loss of visual acuity O.U.
- Scattered scotomas
- May be related to a viral attack
- 50% have iritis
- Most recover to 20/30 within 6 mo.
- No treatment except for iritis
Acute retinal-pigment epithelitis
- 1/4 DD clusters of hyperpigmentation surrounded by a halo of white
- Acuity improves without treatment in 12 weeks
Birdshot retinochoroidopathy
- Age 40-60
- Multiple, discrete, depigmented spots near large choroidal vessels
- Auto-Immune disease of chronic uveitis, disc edema, ect
Geographic helicoid peripapillary choroidopathy
- Geographic choroiditis
- Sudden onset decrease in acuity
- Bilateral recurrent choriocapillaris-RPE disease
- Progressive scarring of choroid from disc outward
- Treatment questionable
Multiple evanescent white dot syndrome
- Age 17-38 females
- Unilateral, multiple white dots in pole
- Macula looks granular
- Visual acuity recovers to 20/20 in 16 weeks
- Does not reoccur
- May follow a case of “Flu”
Pigmented paravenous retinochoroidal atrophy
- Usually bilateral and males
- Atrophy of RPE around nerve head and veins
- Pigment following vessel with de-pigmentation around
- In most cases no effect on acuity but may have scotomas
Recurrent multifocal choroiditis
- Age 14-34 mildly myopic females
- Unilateral or bilateral
- Small multiple yellow-white lesions with a surround of pigmentation
- When active lesions become gray and fuzzy due to vitritis
- If in macula rapid decrease in acuity and metamorphopsia
- May develop neovascularization and fibrotic scarring
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