1. Retina
Mohamed A.Zaher
MSc

2. Anatomy:
Gross anatomy:

5. Microscopic anatomy:

7. 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

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

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

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

11. How to investigate the retina Fundus Flourescein Angiography
Principle:

13. Optical coherence tomography (OCT)

15. B scan Ultrasonography

16. Electroretinography (ERG):

17. 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

18. 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??

20. 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

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

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

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

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

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

28. NPDR Fundus photograph of Left eye showing: retinal hemorrhages
microaneurysms

29. 2- Pre proliferative DR: IRMA – venous beading – increase hge – cotton wool spots

30. IRMA

31. 3- proliferative DR: NVD – NVE -NVI

32. PDR
Please write your comment

33. NVI

34. Diabetic maculopathy:
ischemia - edema

35. Diabetic maculopathy
Please write your comment

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

37. 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

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

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

40. 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

41. 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

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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 2) Hypertensive Retinopathies: - Acute - Chronic

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

52. 2) Tay Sachs disease (Amaurotic Family Idiocy):

53. Retinal Detachment
Definition
Types:
- Rhegmatogenous

54. - Tracional

55. - Exudative

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

57. Treatment:
Scleral Buckling
Vitrectomy
Pneumatic retinopexy

58. Thank you