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15 Cards in this Set

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It's the accumulation of fluid in cyst-like intraretinal spaces within the perifoveal region.
- Fluid-filled microcystic spaces may coalesce into larger cavities, which may eventually form a macular hole.
Cystoid Macular Edema (CME)
What are some causes of CME?
1. Ocular surgery
- Ex: Irving Gass Syndrome
2. Retinal Vascular Disorders
3. Inflammation
4. Medications
5. Retinal Dystrophies
6. Any form of CNV
7. Ocular tumors, systemic disease, etc.
What's the pathophysiology of CME?
Exact mechanism by which fluid accumulates within cystoid spaces in the retina is NOT fully understood.
1) Breakdown of blood-retina barrier
2) Muller cell abnormalities
3) Diffusion of mediators (prostaglandins, etc.) released in the eye.
4) Mechanical factors, such as tractional forces on the macula.
Patient c/o:
- Gradual painless "blurring" or "distortion" of central vision in one eye.
- Pt notices suddenly when "good" eye covered.

Signs:
1. Fundus appearance
- Initial changes subtle (loss of foveal depression)
- multiple cystoid areas best seen with red-free light
2. FA displays characteristic "petalloid" pattern
3. OCT clearly shows cystic spaces and retinal thickening (also holes or traction if present)

What's the Dx & Tx?
a) Cystoid Macular Edema (CME)

b) Tx:
1. Depends on the cause
- Tx of underlying cause may induce resolution
2. Can often be monitored for gradual resolution
3. Post-Op tx is with anti-inflammatories
- NSAIDs (usually topical) and/or steroids to lower edema
4. Oral CAI's sometimes used
- drains fluid from the macula to retina
5. Laser or surgery indicated in specific scenarios
Refers to an "idiopathic" local serous detachment of the macula.
- Occurs most frequently in young men of Type A personality
- Usually seen in otherwise healthy individuals
Central Serous Chorioretinopathy (CSCR)
What's the pathophysiology of CSCR?
1. Probably due to retinal (RPE) and choroidal dysfunction
2. Fluid from "leaky" choriocapillaris filters up through "defects" in the RPE.
3. Fluid then accumulate between neurosensory retina and RPE (retinal detachment), beneath RPE (PED) or both
A 25 y/o male lawyer c/o:
- subacute "blurring" or "distortion" of vision in one eye

Signs:
1. A well-circumscribed round or oval serous elevation of the retina usually affecting the macula
2. The remainder of the retina looks perfectly normal as does the optic nerve
3. The fellow eye looks perfectly normal.

What's the Dx and Tx?
- Dark "smudge" in the middle of his vision
- NO discomfort or history of trauma in an otherwise healthy individual
a) Central Serous Chorioretinopathy (CSCR)

b) Tx:
1. Reassurance
2. Consult with treating physician if using corticosteroid medications
3. Lifestyle modifications may be appropriate
4. Monitor periodically for resolution, complications, and recurrence
5. Longstanding or recurrent cases may benefit from PDT (laser or anti-VEGF's controversial)
60 y/o Asian pt with the following:

Signs:
- Widespread distribution of small PED's
- Extensive pigmentary changes
- Visual prognosis is worse than with typical CSCR.
- MORE severe/much less common form of CSCR

What's the Dx and Tx
a) Chronic CSCR/Diffuse Retinal Pigment Epitheliopathy

b) Tx:
1. Laser photocoagulation therapy for any form of CSCR remains controversial and inconclusive.
2. The area of leakage is often so diffuse that laser is NOT a viable option
3. PDT with Verteporfin appears to have a beneficial effect
What's used to help diagnose CSCR and Chronic CSCR?
Ophthalmic Imaging:
1. OCT
2. Fluorescein Angiography (FANG)
An idiopathic vascular disease characterized by aneurysmal "polyp-like" endings of inner choroidal vessels.
- Causes exudative changes at or near macula
- Often mistaken for ARMD or CSCR
Polypoidal Choroidal Vasculopathy
What's the pathophysiology of Polypoidal Choroidal Vasculopathy?
1. Defective clusters of choroidal vessels form "polyps" of CNV beneath RPE
2. These "polyps" leak or bleed, resulting in recurrent exudative and hemorrhagic detachments of RPE and neurosensory retina
A 60 y/o African American woman c/o:
- Sudden visual impairment in one eye
- Condition is usually bilateral, but asymmetric
Signs:
- Reddish orange nodules may be visible near the disc or macula
- Multiple recurrent "serosanguinuos" PED's and RD's

What's the Dx and Tx?
a) Polypoidal Choroidal Vasculopathy

b) Tx:
1. Observation may be all that is necessary if symptoms tolerable (about half spontaneously resolve)
2. PDT has proven more helpful than in ARMD (anti-VEGF less helpful)
3. Laser of persistent/progressive lesions or their feeder vessels has proven helpful if NOT beneath the fovea.
What's the treatment for CME?
1. Address the underlying cause
2. Treat with NSAIDS/steroids, Oral CAI (drains fluid from the macular to retina), or laser/surgery as indicated
What is the treatment for CSCR?
1. Monitor typical cases first 4-6 months
2. Coordinate PDT tx for chronic/recurrent cases
What's the treatment for Polypoidal Choroidal Vasculopathy (PCV)?
1. Observation may be all that is necessary if symptoms tolerable (about half spontaneously resolve) or direct to retinal specialist based on symptoms.
2. PDT has proven more helpful than in ARMD (anti-VEGF less helpful)
3. Laser of persistent/progressive lesions or their feeder vessels has proven helpful if NOT beneath the fovea.