Retinal Clinical Applications.pdf

Retina Clinical Applications Karen Gil MD, MHSN Retinal Detachment Separation usually between the RPE and the photoreceptors (no intercellular junctions) Bruch’s membrane contains fibronectin and laminin (adhesive glycoproteins) maintain the adherence of RPE cells to it Fluid accumulate in the subre...

Retina Clinical Applications Karen Gil MD, MHSN Retinal Detachment Separation usually between the RPE and the photoreceptors (no intercellular junctions) Bruch’s membrane contains fibronectin and laminin (adhesive glycoproteins) maintain the adherence of RPE cells to it Fluid accumulate in the subretinal space – Photoreceptors no receive nutrients form the choroid – Must be repositioned quickly – Necrosis of photoreceptors can occur Tx: – – – – – Aragon laser Cryopexy Scleral buckle surgery Pneumatic retinopexy Vitrectomy Retinal Detachment NFL INL Retinal Hemorrhages Flame-shaped hemorrhages – Rupture of superficial pre-capillary arterioles (superficial capillary network) – Nerve fiber layer – Small veins – Arrangement of the nerve fibers give a feathered pattern – Common conditions: Systemic hypertension, leukemia, severe anemia, thrombocytopenia, retinal vein occlusion, trauma Dot or blot hemorrhages – – – – Rupture of deep capillaries Inner nuclear layer Rounded in shape Common cause Diabetes Flame-shaped hemorrhages are located in the nerve fiber layer (arrows) and dot-blot hemorrhages are typically located in the inner and outer plexiform and inner nuclear layers (arrowheads). Boat Hemorrhages Rupture of large superficial retinal veins into the space between the retina and vitreous sometimes these bleeds break into the vitreous cavity Common causes – Sudden increase in intracranial pressure – Anemia – Thrombocytopenia – Trauma Retinal Hard Exudates Deep yellow with sharp margins, often circinate are the lipid residues of serous leakage from damaged capillaries Commonly located Outer Plexiform Layer common cause is diabetes Other causes are: – retinal vein occlusion – angiomas (Von Hippel-Lindau Disease) – vascular dysplasias – radiation-induced retinal vasculopathy Histopathology of hard exudates. Note the thick retinal ganglion cell layer (more than 2 to 3 cells thick) (between brackets) identifying the macular region and the periodic acid-Schiff (PAS)-positive dense proteinaceous material (arrows) in the outer plexiform layer (nerve fiber layer of Henle). Cotton wool spots Fluffy gray-white Usually near optic disc retinal nerve fiber layer Micro-infarction Associated Conditions – Hypertension – Diabetes – Connective tissue disease – HIV Histopathology of cotton wool spot. Note the thickening of the nerve fiber layer (between arrows), the characteristic eosinophilic cytoid bodies (arrowheads), and the associated retinal hemorrhage (asterisk). Retinal Drusen Clusters of yellow-orange spots Usually centered around fovea Metabolic debris from retinal pigment epithelium (lipids) Located between the RPE and Bruch’s membrane Associated – Age-related macular degeneration Intraluminal Plaque Usually found at bifurcations cholesterol-fibrin "Hollenhorst plaque" Embolism Associated causes: – Cervical carotid atherosclerosis – Calcified cardiac valve – IV drug abuse Myelinated Nerve Fibers Feathery white clump usually connected to optic disc Extension of myelin onto retinal ganglion cell axons None condition association Cilioretinal Artery Branch of Short posterior ciliary artery CRAO with cilioretinal artery Retinal Vasculitis White cuff that looks like frosting along the vessels Perivenous lymphocytic infiltration Sometimes called "sheathing” Retinal vasculitis occurs in: – – – – Sarcoidosis Behçet's Disease Multiple sclerosis Idiopathic conditions Acute Optic Disc Edema Edema of the optic disc secondary to an increase in intracranial pressure Fluid accumulate within the fibers and disc has an elevation with blurring of the disc margins surface is covered by cotton wool (explosion of damaged axons)spots flame hemorrhages(reflect explosion of vessels under pressure) Bilateral Common causes – Increased intracranial pressure (papilledema) – Infarction – Inflammation – Infiltration (cancer) Histopathology of papilledema. Note the marked swelling and elevation of the nerve fiber bundles in the optic disc (asterisks), lateral displacement of the peripapillary retina from the disc margin (bracket), nerve fiber layer hemorrhage (arrowhead), and subhyaloid hemorrhage (arrow). Age Related Macular Degeneration Two classifications – Dry or non-neovascular or atrophic – Wet or neovascular or exudative Cause severe visual loss Characterized by drusen and neovscularization Degenerative changes of RPE is believed to be a consequence of abnormal digestive mechanisms resulting in accumulation of abnormal material in the RPE Age Related Macular Degeneration