Scleral Indentation PDF

Purposes Examine peripheral fundus by displacing tissue inward View peripheral fundus in profile Enhance contras...

Purposes Examine peripheral fundus by displacing tissue inward View peripheral fundus in profile Enhance contrast between normal and abnormal retina Scleral Indentation Indications Signs / symptoms of RD, retinal breaks in symptomatic pts with flashes or axial myope H/o blunt trauma High axial myopia Yang, 2024 -aka scleral depression -pushing the tissue inward or pushing sclera from the outside to enhance the contrast between normal and abnormal such as retinal detachments in symptomatic pts 5  Scleral Indentation Scleral Indenter Yang, 2024 6  Scleral Indentation Yang, 2024 -meant to indent the sclera from the outside and at the same time using your 20D lens 7  Scleral Indentation Yang, 2024 -scleral indentation can be done over the eyelid 8  Scleral Indentation Yang, 2024 -can also be done directly on sclera 9  Scleral Indentation Yang, 2024 -normal retina with scleral indentation -this area of the retina is elevated towards you bc you’re depressing the sclera from the outside - 10  Scleral Indentation Yang, 2024 -this person has a break in the retina and if we indent the sclera the area will come forward and enhance the view -this is a horse shoe ex 11  Contraindications Scleral Recent intraocular surgery Recent hyphema Indentation Recent penetrating injury Ruptured globe Yang, 2024 -scleral indentation does not activate existing retinal tears -the list above is when we shouldn’t do scleral indentation but overall performing it is safe 12  Learning Objectives 1 2 3 Learn key features of the following: Learn to differentially Learn indications for diagnose these pathologies treatment Peripheral retinal degenerations RPE hypertrophy / hyperplasia Retinal breaks and detachment Choroidal detachment Yang, 2024 13  Peripheral retinal degenerations Peripheral RPE hypertrophy / hyperplasia Retinal Lesions Retinal breaks and detachment Choroidal detachment Yang, 2024 14  Peripheral Retinal Degenerations Vitreoretinal Intraretinal RPE/Chorioretinal degenerations degenerations degenerations Lattice degeneration Cystoid degeneration Reticular degeneration Snail track degeneration Retinoschisis Pavingstone degeneration Vitreoretinal tuft White without pressure Yang, 2024 -peripheral retina degeneration à relatively common -OCT plays a role in differential diagnosis to locate the layer the lesion is in 15  Atrophic condition Lattice Loss of ILM Pocket of liquefied vitreous Degeneration Adherence of vitreous to margins Intraretinal atrophy over time Yang, 2024 -starts in the interface between the vitreous and inner retina -looks like vitreous opacification at the margins of the lattice degeneration -the atrophy spreads to intraretinal layers over time 16  Wide variations in fundus appearance Lattice Oval, elliptical, spindle, or linear patches Degeneration Crisscrossing white lines (“lattice”) in ~10% of lesions Underlying pigment hyperplasia Yang, 2024 -underlying pigment epithelium becomes hyperplastic à pigmented lattice 17  ~6-10% of general population More common in myopic eyes Bilateral ~30-50% Lattice Isolated or multifocal Degeneration Within the equator or anterior to equator Commonly in inf/temp quadrant Atrophic holes with/without local RD Asymptomatic Yang, 2024 -seen in axial myopes but can be seen in hyperopes or emmetropes -there may be isolated or multiple lattices -atrophic holes are often found localized 18  Lattice Degeneration Yang, 2024 -typical early lattice degeneration -note tapering of blood column as it approaches the lesion -vessel is attenuated but continues as if nothing has happened -there is a atrophic hole that is circled -more pigmented on the right pic 19  Lattice Degeneration Yang, 2024 -atrophic hole with small detachment is circled with little opacity so it is very localized 20  Lattice Degeneration Yang, 2024 -pigmented lattice degeneration -the crisscrossing lines is very uncommon 21  Lattice Degeneration Yang, 2024 -each arrow represents the OCT pic -first OCT à retinal surface is relatively smooth and RPE is intact but posterior hyaloid membrane looks thickened and is hyper reflective -second OCT à there is a intra retinal adhesion -third OCT à thinner inner retina and RPE looks more hyperreflective? -fourth OCT à ?? 22  Lattice Degeneration Yang, 2024 -full thickness missing retinal areas seen in OCT - 23  Complications Lattice Stable or very slowly progressive Retinal tears can occur Degeneration ~1% of patients with lattice degeneration develop RD ~20-30% of RD’s associated with lattice degeneration Yang, 2024 -retina tears can occur with the posterior vitreous detachment pulling on these in the retina -retina degeneration is very rare in those who have lattice degeneration 24  Degeneration of the neural elements of retina Groups of glistening white dots in a translucent band Snail Track ~10% of general population Degeneration Young and myopic eyes Within or just anterior to the equator May be a clinical variation of lattice degeneration Yang, 2024 -degeneration of neural elements leading to atrophy of the tissues with lipid deposits in the inner retinal surfaces -precursor of lattice degeneration 25  Snail Track Degeneration Yang, 2024 -resembles the slime of snail -snail track can have holes and focal fitting similar to lattice degeneration 26  Snail Track Degeneration Yang, 2024 -can appreciate focal adhesions at the edges 27  Snail Track Degeneration Yang, 2024 -third pic à full thickness tear and with operculum and shallow retinal detachment -fourth pic à severe vitraction adhesion 28  Snail Track Degeneration Yang, 2024 29  Complications Snail Track Degeneration Similar to those of lattice degeneration Yang, 2024 -so retinal tears 30  Management Lattice / Debatable prophylactic laser intervention for lattice/snail track degeneration Snail Track Likely to treat high-risk patients Degeneration Fellow eye with RD Strong FOHx of RD Symptomatic retinal breaks Highly myopic Aphakic Lattice in only seeing eye Yang, 2024 31  Laser Prophylaxis Yang, 2024 -white laser spots bc there is relatively new spots so just got it done but over time the spots become pigmented 32  Laser Prophylaxis Yang, 2024 -pale spots become pigmented over time 33  Small foci of vitreous traction Slightly elevated May have a cystic appearance Vitreoretinal May be surrounded by hyperplastic RPE Tuft DDx: flap tears Low risk of retinal tear/hole/RD No treatment required if asymptomatic Yang, 2024 34  Vitreoretinal Tuft Yang, 2024 -this area is elevated 35  Vitreoretinal Tuft Yang, 2024 36  Vitreoretinal Tuft Yang, 2024 -can affect vitreoretinal layers and show as cystic pieces 37