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Degenerative Retinoschisis

-usually bilateral, inferior temporal
-can show absolute scotoma
-flat RS - inner layer of flat RS smooth, beaten metal appearance
-bullous RS - thin transparent to ballooning in appearance.  33% of pts develop RD.

TX

-no breaks - yearly F/U
-if progression - retinal consult
-RS with inner layer break - 6mo F/U
-any vitreoretinal traction - retinal consult
Lattice Degeneration

-thinning of the retina
-young patients
-PVD with lattice reduces RD chance to 0%.
-RPE hyperplasia and tiny glistening yellow flecks
-sclerosed vessel formation (fishboning) increases with age
-white without pressure or lacunae of vitreous overlying the lesion

Tx

-must educated all pts on signs/sxs of RD
-lattice as only sign - yearly F/U
-lattice w/ flashes/floaters - 6mo F/U if no holes/tears
-lattice w/ atrophic holes but asymptomatic and no risk factors for RD - 6mo F/U
-lattice with breaks at the margin of lesion - retinal consult
Risk factors for RD
Vitreous degeneration
Younger pts
Myope
History of RD in fellow eye
Strong FHx
Breaks to retina and symptomatic
Cataract surgery
Other signs of retinal thinning
Vitreoretinal traction in elderly pts
Aphakia
Snail Track Degeneration

-thinning of retina
-lattice without fishboning appearance

Tx

-inferior - 6mo F/U
-superior - retinal consult
Atrophic Retinal Hole

-red, round circular lesions
-fluid may seep into edges -> RD
-pigment indicates 3 months stability
-volcano appearance with scleral depression
-seen in cystoid degen, snail track, lattice, pars planitis
-most common cause of retinal breaks

Tx

-isolated holes/asymptomatic - yearly F/U
-isolated hole/asymp. - with cuff of edema or focal detachment <1DD, no focal RPE hyperplasia - 3-6mo F/U
-isolated hole/asymp. - edema, >1DD - retinal consult
-isolated hole and symptomatic - retinal consult
-isolated holes with flap tear - retinal consult
Operculated Retinal Holes

-typically occurs from ora to equator
-red round hole with free floating plug of retina
-may be surrounded by white with or without pressure and localized cuff of edema
-good sign of pigment develops around the hole

Tx

-fresh holes - reexamine in 6 weeks then 6-12 months
-asymptomatic hole and first time examined - reexamine in 6-12 mo
-multiple holes and asymp - 6 mo
-asymp with edema cuff, no pigment - 3 mo
-asymp with edema cuff, with pigment - 6 mo
-asymp, aphakia, RD in one eye - retinal consult
-cuff of edema >2DD - retinal consult
Linear retinal tear

-retinal break associated with vitreoretinal traction
-usually occurs if retina is thin, trauma, aphakia, or myopia
-tears appear red surrounded by atrophic grey tissue
-apex of point usually points towards PP due to downard pull of vitreous.

-retinal consult in all cases
Retinal Dialysis (tear at the ora < 90 degrees)

-usually trauma
-typically in males under 40
-no tendencies towards myopia
-60% asymptomatic
-IOP may increase or decrease

-after initial DFE, any trauma needs to be followed up again in 60-90 days to ensure no dialysis.
Giant Retinal Tear

-retinal tear that has folded ovver onto itself
-righ risk for RD
-mostly idiopathic, otherwise trauma
-flashes/floaters

-retinal consult ASAP
Commotio Retinae

-bruise to the retina due to blunt trauma
-swelling is whitish with black/blue hemorrhaging

-scleral depression to evaluate for breaks
-RTC 2wk F/U, as swelling subsides, holes may be revealed
Rhegmatogenous Retinal Detachment

-peak incidence at 60yo
-results of breaks and collapsing vitreous with percolating fluid under sensory retina
-loss of underlying choroidal detail
-B scan helps outline detachment
-IOP may be elevated or decreased

-immediate referral if fresh
-longstanding - consult w/in 2 days
Retinitis Pigmentosa Signs

-generalized diffuse pigmentation of RPE.
-pigment may clump and form strands forming bone spicule appearance.
-pigment surrounded by motheaten areas of atrophy
-choroidal vessels may be visible.

-artery attenuation, more in PP as dz progresses.

-retina may look edematous
-wrinkling of ILM

-drusen on ONH

-CME

-flecks of pigment in ant. vitreous and syneresis. 

-PSC
RP Tx
-genetic counseling
-driving restrictions
-threshold VFs to monitor progression
-low vision consult
-vitamin A daily
-examine medical Hx for deafness, partial hearing loss, polidactily, heart problems, kidney dz
-grid photocoagulation for CME
-cataract extraction if PSC
Syphilitic (Leutic) chorioretinitis
-looks similar to RP, but:

-severely affected, asymmetrical VFs
-hutchinsons teeth (smaller teeth, widely spaced with notching within each tooth)
-depressed nasal bridge
-deafness
-mental retardation
Fundus Flavimaculatis (Stargardts)

-bilateral, progressive
-blurring of central vision in 20s
-VAs 20/50 - 20/200
-pt' s prefer low light due to cone dropout

Early stargardts pictured:
-loss of foveal reflex and faint yellowish/copper bullseye around macula
Fundus Flavimaculatis (Stargardts)

-Further progress pictured:
-zone of grayish yellow depigmentation and stippling around macula
-yellow flecks develop peripheral to macula
Fundus Flavimaculatis (Stargardts)

-advanced pictured:
-further atrophy at macula
-flecks move into mid periphery

FANG reveals dark or silent choroid
Vitelliform Dystrophy (Best's Dz)

-egg yolk appearance at macula
-starts around 10-12yo
-EOG is differential test, asymmetry between the eyes
-egg yolk due to accumulation of lipfusion in RPE
-egg yolk only mild dec. in VAs
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