Retina Mohamed A.Zaher MSc

Anatomy: Gross anatomy:

Microscopic anatomy:

Physiology: Rods sense brightness To brain Cones sense color   Cones sense color To brain The retina, in the back of your eye, has cells that are sensitive to light. They connect directly to your brain

Function: Retinal pigment epithelium: nutrition, vit A metabolism, heat sink, … Rods: dim illumination Cones: bright illumination, color vision Blood supply: Central Retinal Artery Choriocapillaris

How to examine the retina Structure: Indirect ophthalmoscope Direct ophthalmoscope Slit lamp with auxiliary lenses e.g. Volk 90 D

Function: Visual acuity e.g. Snellen acuity Color vision e.g. Ishihara color plates Field of vision (perimetry)

How to investigate the retina Fundus Flourescein Angiography Principle:

Optical coherence tomography (OCT)

B scan Ultrasonography

Electroretinography (ERG):

What are the retinal symptoms Diminution of vision: sudden, rapid, gradual Diminution of night vision Disturbed color vision: yellow-blue Photopsia, metamorphopsia Floaters Field defects

Retinal Vascular Diseases: 1)Central Retinal Artery Occlusion: Causes Symptoms Signs: Pupil Fundus Picture DD: causes of sudden loss of vision causes of cherry red spot Treatment: value??

2) Central Retinal Vein Occlusion: Causes Types: ischemic non-ischemic Symptoms Signs: Pupil Fundus Picture DD: causes of rapid loss of vision causes of retinal hemorrhage Complications Treatment

L: Lamina cribrosa C : Central retinal Vessels N: Nerve fiber layer S: Sclera A: nerve bundle G: Glial tissue

Ischemic CRVO Fundus Fluorescein Angiography of the left eye showing: Areas of retinal ishemia NVDs NVEs

3) Retinal arteriosclerosis: changes in Artery Vein A-V crossing

Retinopatheies: Diabetic Retinopathy: Risk Factors Pathophysiology: microvascular leakage occlusion

Stages: 1- Non proliferative DR: microaneurysms edema hard exudate dot-blot hemorrhage

NPDR Fundus photograph of Left eye showing: retinal hemorrhages microaneurysms

2- Pre proliferative DR: IRMA – venous beading – increase hge – cotton wool spots

IRMA

3- proliferative DR: NVD – NVE -NVI

PDR Please write your comment

NVI

Diabetic maculopathy: ischemia - edema

Diabetic maculopathy Please write your comment

Complications: haemorrhage Retinitis proliferans Tractional RD Treatment: - control DM - IV injection (Avastin) - Laser photocoagulation - Vitrectomy

MCQs A young lady presented with bilateral sudden loss of vision. On examination, VA was bilateral no PL. The pupillary reactions were normal and both fundi showed no abnormal finding. In such a case we always suspect: CRAO Retrobulbar neuritis Hysterical blindness RD

In the above case, the most useful investigation is: Ultrasonography OCT FFA VEP

Central retinal edema is NOT present in: CRAO CRVO Commotio retinae Macular hypoplasia

A female patient 50 years old, known to be diabetic for the last 5 years, presented with marked drop of vision of the left eye. On examination, the right fundus was normal, the left fundus showed edema of the optic disc and retinal hemorrhages. This picture is suggestive of: NPDR PDR Left CRVO Left CRAO

Each of the following can be a predisposing factor for CRVO EXCEPT: 1) Hypertension 2)Open angle glaucoma 3)Hypermature senile cataract 4) Diabetes milletus

Flourescein Angiography is NOT of diagnostic value in: Diabetic retinopathy Diabetic maculopathy BRAO Rhegmatogenous RD

A diabetic patient suddenly developed rapid loss of vision A diabetic patient suddenly developed rapid loss of vision. On examination, the anterior segment was normal. The red reflex was dark. Which of the following invesigation do you recommend? X ray of the orbit Ultrasonography ERG FFA

The presence of cotton wool patches denotes the following EXCEPT: Retinal ischemia Infarction in the nerve fiber layer Active exudation from a retinal microaneurysm PDR

A diabetic patient was found to have BCVA 6/12 A diabetic patient was found to have BCVA 6/12. FFA revealed focal leaking microaneurysms into the macular area. Your plan for treatment is to do: Grid pattern photocoagulation Focal photocoagulation PRP PRP and focal photocoagulation

A hypertensive patient developed an acute attack of marked diminution of vision. On fundus exam all of the following are present EXCEPT: Macular star Macular hole RAO RVO

A female patient on contraceptive pills for 5 years developed rapid painless marked diminution of vision in one eye, what is the most diagnostic examination you would do: Tonometry Angle of AC Fundus exam Field of vision

A female patient is receiving contraceptive pills for long time A female patient is receiving contraceptive pills for long time. She complained lately of rapid painless diminution of vision in one eye. Three months later she complained of ocular pain and redness. Your lines of treatment could be one of the following EXCEPT: Β blocker Carbonic anhydrase inhibitor Pilocarpine Non steroidal anti inflammatory drops

2) Hypertensive Retinopathies: - Acute - Chronic

Retinal Degeneration Retinitis Pigmentosa: - Aetiology - symptoms: rods maily - signs - investigations: ERG – Visual field - association: cataract, glaucoma - treatment

2) Tay Sachs disease (Amaurotic Family Idiocy):

Retinal Detachment Definition Types: - Rhegmatogenous

- Tracional

- Exudative

Symptoms: retinal symptoms Signs Investigations: U/S Prophylactic treatment: Argon laser Cryotherapy

Treatment: Scleral Buckling Vitrectomy Pneumatic retinopexy

Thank you