Ocular Dz 4: Peripheral Retinal Degenerations

Front 1

Refers to the formation of an area of confluent tiny vesicles within the peripheral retina, such that it looks thickened or LESS transparent.
- Always extends from ora serrata posteriorly and circumferentially
- Does NOT by itself lead to RD

Back 1

Microcystoid Degeneration

Front 2

What's the management of Microcystoid Degeneration?

Back 2

1. Does NOT require tx or referral
2. Recognize as a generally benign condition
3. Document & monitor for progression to retinoschisis
4. Discuss symptoms of RD with patient, but reassure unlikely to occur.

Front 3

Refers to patches of chorioretinal atrophy aligned in a row parallel to the ora serrata.
- Represents thinned INTACT retina & choroid overlying visible sclera
- Does NOT lead to RD!
- occurs in roughly 1/4 of normal eyes

Back 3

Pavingstone Degeneration

Front 4

What's the management for Pavingstone Degeneration?

Back 4

1. Recognize as NOT due to other pathology
2. NO need for tx or referral.
3. Merely document & educate the patient
4. Understand that there is NO "break" in the thinned, degenerative retinal tissue

Front 5

Refers to peripheral perivascular pigmentation which may extend posteriorly to the equator.

- Occurs mostly in older patients
- It's NOT associated with pathology, decreased visual function or RD

Back 5

Reticular Pigmentary Degeneration

aka:

Peripheral Senile Pigmentary Degeneration

Tapetochoroidal Degeneration

Front 6

What's the management for Reticular Pigmentary Degeneration?

Back 6

1. Recognize as a benign age-related change and NOT pathological.
2. Differentiate from similar appearing conditions which are pathological (RP, etc)
3. Document, but probably NO need to explain this relatively normal finding to patient.

Front 7

Refers to the appearance of drusen OUTSIDE the macular region.

- Commonly observed in older pts
- NOT associated with AMD
- Does NOT lead to RD or any other problems

Back 7

Peripheral Drusen

Front 8

What's the management for Peripheral Drusen?

Back 8

1. Differentiate between this benign manifestation of drusen and that associated with progressive macular changes (AMD)

2. Clearly communicate findings to patient with reassurance that they are NOT at increased risk for AMD.

3. Monitor regularly (AMD, etc. not prevented)

Front 9

An elongated area of thinned (atrophic) retina beneath a pocket of liquefied vitreous which is surrounded by strong vitreal attachments at the margins of the lesion.

- Very common especially in myopes
- Pathogenesis is uncertain
- Present is up to nearly half of eyes with RD!

Back 9

Lattice Degeneration

Front 10

What's the clinical SIGNS for Lattice Degeneration?

Back 10

1. Bilateral
2. Seen in the superiotemporal quadrant
3. Develop early (teen's and 20's)
4. White lines, "snowflakes," pigmentation and/or small holes often found within lesion.

Front 11

What's the management for Lattice Degeneration?

Back 11

1. Lattice Degeneration without retinal breaks does NOT require treatment or referral
2. Prophylactic laser may be considered in specific limited circumstances
3. All patients should be monitored regularly
4. All patients should be advised of symptoms of RD and need for immediate care if such occur

Front 12

Should patients with Lattice Degeneration be worried about retinal detachment (RD)?

Back 12

a) Most patients with Lattice Degeneration (LD) do NOT develop RD.

b) RD may develop in patients with LD:
1. following flap tear formation during PVD
2. from tears at posterior margin of lesion
3. from holes within lesion (rarely)

Front 13

A peripheral retinal degeneration similar to LD:
- characterized by elongated patches of "frosted" looking retina in the periphery
- usually LONGER than those seen in lattice
- overlying vitreous liquefaction (like lattice), but without strong vitreoretinal attachments
- may exhibit "holes" within the lesions

Back 13

Snailtrack Degeneration

Front 14

What's the management for Snailtrack Degeneration?

Back 14

1. Snailtrack Degeneration without retinal breaks does NOT require tx or referral.
2. Prophylactic laser may be considered in specific limited circumstances
3. All patients should be monitored regularly
4. All patients should be advised of symptoms of RD and need for immediate care if such occur

NOTE: Similar management/tx as Lattice Degeneration.

Front 15

Describes the whitish opaque appearance of islands of peripheral retina that are attached more strongly to the cortical gel than normal.

Back 15

White With & Without Pressure

Front 16

What's a major difference between "White With Pressure" vs "White Without Pressure?"

Back 16

1) White With Pressure
- it's only observed with scleral indentation

2) White Without Pressure
- constant

Front 17

What's the management for White Without Pressure?

Back 17

1. A common ancillary finding during routine DFE of asymptomatic patients
2. Rarely causes problems, but giant retinal tears have been known to occur at posterior border
3. Document and educate patient about symptoms of RD

Front 18

A small area of retinal elevation occurring where focal vitreous traction "pulls up" the retina.

Back 18

retinal tuft

Front 19

What are some signs, symptoms, and tx in patients with retinal tuft?

Back 19

1. Very common (mostly in adult eyes)
2. Seen as a small, light-colored, raised area of retina (may be pigmented at base)
3. Usually an incidental finding (NO symptoms)
4. Does NOT require tx!

Front 20

This atrophic condition is often seen in the equatorial region of highly myopic eyes.
- Represents a thinning of choroid/retina
- Holes may form within the atrophied retina, leading to RD
- These holes are often difficult to see due to lack of contrast between retina and choroid

Back 20

Diffuse Chorioretinal Atrophy

Front 21

What 4 major conditions that occur more frequently in myopia?

Back 21

The following conditions occur more frequently in myopia:

1. Lattice Degeneration
2. Snailtrack Degeneration
3. Diffuse Chorioretinal Atrophy
4. Macular Holes

Front 22

What 3 major processes contribute to increased RD with myopia?

Back 22

1. Vitreous Degeneration occurs with myopia
2. PVD occurs earlier with myopic individuals
3. Cataract tx is often more associated with RD in myopic patients
- CAT surgery with vitreous loss
- Laser posterior capsulotomy

Front 23

Why should high myopic patients have periodic DFE check ups?

Back 23

High myopic patients should have periodic DFE's to check for asymptomatic retinal breaks and detachments.

Front 24

Which conditions do NOT lead to RD?

Back 24

1. Microcystic Degeneration
2. Pavingstone Degeneration
3. Reticular Pigmentary Degeneration
4. Peripheral Drusen

Front 25

Which conditions may LEAD to RD?

Back 25

1. Lattice Degeneration
2. Snailtrack Degeneration
3. White With & Without Pressure
4. Diffuse Chorioretinal Atrophy