Microcystoid Degeneration & Senile Retinoschisis PDF

Microcystoid Degeneration Typical type Reticular type Most common degenerative lesion Less common Small bubbles or vacuoles near ora Cysts at the level o...

Microcystoid Degeneration Typical type Reticular type Most common degenerative lesion Less common Small bubbles or vacuoles near ora Cysts at the level of NFL; more superficial May have pseudo-hole appearance Located more posteriorly than typical type Located in the OPL and INL Mostly bilateral and symmetrical More common in temporal and superior quadrants Yang, 2024 -intra-retinal detachment -typical type is more common and found in most adults increasing severity with age - 38  Microcystoid Degeneration Yang, 2024 -left pic is typical with non harmful lesions -right pic is reticular and is a bit more central 39  Microcystoid Degeneration Yang, 2024 40  Complications Microcystoid Mostly benign Degeneration May progress to degenerative retinoschisis Yang, 2024 -does not predispose pt to retinal detachment -not that common lesion 41  Degenerative retinoschisis Extension of microcystoid degeneration ~2-4% of population above 40 years of age Senile Bullous elevation Retinoschisis Bilateral commonly Located in inf/temp quadrant Immobile with eye movement Asymptomatic Yang, 2024 -seen in high axial myopes as well -extension of microcystoid degeneration can lead to split in neural sensory retina -bullous dome shaped lesion 42  Typical form Reticular form Senile Split in outer plexiform layer Less common Retinoschisis “Snowflakes” Split in nerve fiber layer Inner layer markedly elevated Yang, 2024 -retina spits at the OPL -snowflakes are white dots that are remanent of the muller cells breaching the outer and inner splits of the retina 43  Senile Retinoschisis Yang, 2024 -the white microcystoid lesion when it becomes continuous, it becomes elevated in the OPL à diagrams 1 and 3 -in the reticular microcystoid at the level of RNFL, the spaces become continuous and elevated à diagram 2 and 4 44  Senile Retinoschisis Yang, 2024 -suble elevation in the retina 45  Senile Retinoschisis Yang, 2024 -this is with scleral indentation 46  Senile Retinoschisis Yang, 2024 -becomes more apparent without scleral depression -snowflakes are seen at the edges of the retina 47  Senile Retinoschisis Yang, 2024 -dome shaped smooth surface with partial thickness with retinal elevation -split seen in neurosensory retina -can see the remnants of the muller cells reaching the outer and inner retinal splits and shows up as snowflakes 48  Ou e hol ter reti nal Yang, 2024 retinoschesis -large area of retinoschisis -OCT is done across the area 49  Senile Retinoschisis Yang, 2024 50  Complications Absolute VF defects May enlarge to involve posterior pole Senile Associated with ~3% of RD Retinoschisis If holes in outer layer only, may develop RD slowly If holes in both inner and outer layers: Likely to cause RD May require surgery Yang, 2024 -asymptomatic of VF defect bc its in the far periphery 51  Senile Retinoschisis Yang, 2024 52  Distinctive white/gray appearance without indentation ~30% of general population White without Often found bilaterally in temporal periphery Pressure Located between equator and ora No treatment needed Yang, 2024 -increases instances with age -easier seen in pt with pigment bc there is more contrast - 53  White without Pressure Yang, 2024 54  White without Pressure Size, shape, location can change Can be seen around other degenerations DDx Subclinical RD Retinoschisis Yang, 2024 -appears bounded by brown/red lines -sometimes called dark without pressure -looks like a retinal break due to contrast -follow the blood vessels, there is no bump so that means its WWP and not a RD 55  Debatable etiology White without Optical illusion? Pressure Light reflection from vitreoretinal interface? Outer retinal structural abnormality Yang, 2024 56  White without Pressure Yang, 2024 -red line demarcates the normal retina and where there is WWP -extra white hyper reflective areas signals coming from the outer retina 57