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Choroid - Disease 2 examen 4 Dr/B
Terms in this set (20)
-Proliferation of spindle cells (small melanocytic cells)
-Benign, flat, greenish gray spot with distinct borders (usually*)
-The bigger the size the more suspicion of malignancy. Usually will be from 1mm to 5mm. The elevation is minimum of about 1-2mm
-Can have sub-retinal fluid that can lead to serous detachment. Overlying drusens or RPE pigment clumping can also be present.
-Prevalence = 5% of population, most in blonde white people when young
-DDX: Melanoma (bigger with lipofuscin; CHRPE - do R/G filter (nevi won't be seen)
-Testing: FA = hypofluoresce; ICGA = sees extension better; F/U = suspicious cases in 6mo
-Do not have symptoms
-Located on the posterior pole.
-Proliferation of cells especially epithelioid cells (worse prognosis if more epithelioid cells)
-Associated with chromosome 3 defects
-located in choroid but can spread and turn into an anterior melanoma. 3mm from ONH
-It's an oval or round shape and elevated that can have different colors, they are around 5-15mm in size and 2-15mm in thickness. Also, may contain lipofuscin pigment clumping, folds, subretinal fluid, detachments, vitreous hemes, secondary cataracts, choroidal neovascularization. Can have a collar stud amelanotic appearance and sentinel vessels (dilated episcleral blood vessels)
-Metastasis important factors: size, thickness and proximity to nerve.
-Can go to liver, lungs, brain, bones. Survival rate is 5-7yrs.
- More common in white population and appear during the middle age 40-60y/o, people with family history and those who like to sunbathe.
-US: dome elevation with excavation
-FA: Early hyperfluorescence and end leakage
-factors for treatment: size, location, VA, age and systemic medical history, motivation
-tx: enucleation and size/ extension of tumor, plaque brachytherapy, proton bram radiotherapy, transpupillary laser thermotherapy, local resection.
-complications of treatment: severe retinopathy, macular edema, exudation, epiretinal membrane. Secondary cataracts, ONH edema, retinal detachment, keratitis, depigmentation of lids
-Would have symptoms
Pigmented dark lesion, benign most of the time. Sits on top of the nerve, flat 1-2mm
Probably a derivative of a nevus, papillitis, APD, decrease VA and FA hypofluoresce
Tumor that is whitish/yellowish, elevation is minimal, may have pigment deposits.
Affects VA significantly
FA has early hyperfluoresce
must have presence of systemic disease (other tumor in body). Usually lung in men and breast in women.
Women have worse prognosis
Amelanotic type of choroidal osteoma
Tumor from bone that goes into the choroid. It is whitish.
Has characteristic shape and border.
Round granular surface with scalloped borders, vascular spiders, always around the ONH and macula.
Circumscribed choroidal hemangioma
Benign vascular tumor with formation of vascular channels. Overlying fibrous metaplasia.
Mildly elevated orange oval mass. Elevation 2-4mm, size 4-8mm
Increase hyperopia, metamorphopsia
30-40yo, tendency to progress a lot even more so in pregnant women.
Circumscribed = delineated
Imitates a central serous retinopathy, differentiate with a FA
US = see elevation wo excavation.
Diffuse choroidal hemangioma
Benign vascular tumor
Diffuse large red fundus lesions with tortuous vessels.
Pigmentary changes that might look like RP
Can develop neovascular glaucoma
Starts at an early age, progress slowly and extend into choroid.
Can be associated to systemic disease like Stuge-Weber syndrome
US = mildly elevated lesion
Elastic degeneration of Bruch's membrane that look like brown-red or greyish radiating lines and radiate from the ONH out.
Streaks or breaks at the level of choroid/Bruch's
Systemic conditions that present them are PXE (would have Peau d'orange fundus), Paget's, Ehlers-Danlos syndrome, Sickle cell disease
Drusens in the ONH
FA = hyperfluoresce in the streaks
Folding, wrinkling, grooves, striae
Compression or congestion with minimal contraction = RPE/Bruch's is thick = dips = hypofluoresce
Stretching = RPE/Bruch's is thin = crest = hyperfluoresce
OCT will confirm difference in thickness
Tumors, hypotony, inflammation/idiopathic, neovascular membrane, retrobulbar mass, retinal detachment, papilledema, extraocular hardware/juxtascleral/ orbital. Treat underlying cause
Found around the posterior pole. Can be horizontal, vertical or oblique.
Anterior-posterior globe compression, horizontal globe expansion/ stretching.
Concentric thick whitish/greyish crescent shaped lesions that with time accumulate pigment.
Can be caused by trauma
Subretinal hemorrhage, vitreous hemorrhage and commotion retinae, CNVM, fibrovascular tissue traction.
Hereditary dystrophy affecting choroid primarily the choriocapillaris and the RPE-photoreceptors complex.
Nyctalopia, vision loss
Stage 1 = granular RPE mottling (salt&pepper)
Stage 2 = patches of RPE and choroidal drop out that coalesce out to in (white bc scleral)
Stage 3 = extensive atrophy/ONH/Macula
X-linked recessive/ CHM gene. Young pts, they become blind by the time we are 40.
Affected males/female carriers. The female carrier presents stage 1
Diffused not localized, progressive
ERG = scotopic is completely gone and photopic is going to be significantly diminished.
Atrophic patches changes that from a pattern, demarcated scalloped margins that connect and keep growing.
Nyctalopia, vision loss, atrophy, attenuation of retinal vessels, early cataract, vitreous degeneration, myopic shift
Piridoxine = B6 vitamin
Presents in the 1st decade
Ornithine levels are high, lysine levels are low.
Systemic signs = very thin straight hair, cardiac problem and convulsions.
ERG = photophic and scotopic are diminished
Central Areolar atrophy of the choroid
Atrophy of the choriocapillaris and RPE
Localized at the macula
Demarcated round and symmetrical geometrical lesions in macula with attenuation of vessels and possible RPE detachment
Autosomal dominant/ CACD gene and the PPH2 gene
FA = hyperfluorescence lesion
ERG = normal or very mildly affected
is a delayed hypersensitivity response to the retinal rod outer segment.
Mutton-Fat KPs , Dalen Fuchls nodules
Enucleation, Cycloplegic, steroids, immunosuppressive, antimetabolite therapy
folic acid supplement B9
If given methotrexate, what do you need to add.
Post surgical Fungal endophthalmitis
a. 2-4 weeks after sx and despite steroids there is still iritis. You still see something like intermediate uveitis. Then the culprit is candida species.
b. More prevalent in immunocompromised patients
c. Indolent inflammation = small signs and symptoms, but can have an intermediate uveitis
d. Sometimes you don't see them bc is being masked by the post-surgical use of steroids.
treatment of choice is vitrectomy
Chronic bacterial blepharitis
Post surgical bacterial endophthalmitis is caused by what?
Fundus findings do not correlate with VA
RP = Cone-Rod dystrophy
a. Patient 45yo is coming in with slight decreased VA on both eyes, vessels attenuation, pigmentary changes in central retina in circinate pattern. Mildly constricted fields. ERG decreased amplitude in photopic. Slightly decreased amplitude in scotopic.
FAF= Garners = APC gene
A patient everything unremarkable except for bear track lesions in peripheral retina. MHx colorectal cancer. Send out for gasto for colonoscopy and it show familial adematous polyposis...what will be the first gene affected on this condition.
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