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Retinoschisis & Choroidal Detachment - PSD B15
Terms in this set (22)
What condition is a "splitting" of/within the retina which occurs due to degeneration and more commonly affects hyperopic eyes?
Degenerative Retinoschisis ; note it is not the entire separation of the neurosensory retina from the RPE (such as in the case of a RD)
What is the prevalence of degenerative retinoschisis?
1 in 20 people after teen years
What type of VF defect is seen in degenerative retinoschisis?
Absolute VF defect; Remember that RDs have a relative VF defect. If you have difficulty remembering absolute vs. relative, think of the three layers in the retina that play a role in transmitting the image to the brain (Photoreceptors > Bipolar cells > Ganglion cells). In a RD, these layers are all still connected as the neurosensory retina is still fully intact. In a retinoschisis, these layers are separated, resulting in a broken circuit, leading to the absolute scotoma. Helpful thing to know for Part 1 too!
What quadrant does degenerative retinoschisis generally occur in?
Most commonly in the inferior temporal periphery.
What type of RD does retinoschisis look most similar to?
How might one differentiate retinoschisis from RD?
Retinoschisis is bilateral 80% of the time. There is no full thickness retinal break observed in retinoschisis. The surface is smooth and not "wrinkled".
What is the appropriate management of retinoschisis?
They are usually monitored without treatment, as they rarely advance to the posterior pole and the patient tends to remain completely asymptomatic.
If retinoschisis starts moving posteriorly and progressing, what is the appropriate management?
Prophylactic laser may be considered
What occurs when fluid accumulates between the choroid and sclera (within the suprachoroidal space) and may be mistaken for a retinal detachment?
Choroidal detachment, or choroidal effusion
What is the most commonly associated cause of a choroidal detachment?
Recent intraocular surgery (especially glaucoma filtering surgery)
Aside from recent intraocular surgery, what are other causes of choroidal detachment?
Hypotony, trauma, inflammation (Topamax), vascular problems, and idiopathic (rarely)
If a choroidal detachment is extensive, what changes in the anterior segment may occur?
The AC may be shallow and IOP may be abnormal.
True or false- IOP can be high or low secondary to choroidal detachment.
True- It is low if the choroidal detachment is caused by hypotony or high if it is hemorrhagic.
How does a choroidal detachment appear?
It tends to be brown in color, smooth, relatively immobile, does not extend to the posterior pole (may obscure it), and multiple "lobes" may be present.
What are a few conditions we must differentiate a choroidal detachment from?
Tumors (brownish elevation could be a choroidal melanoma), RD, retinoschisis, and scleral buckle
How are choroidal detachments managed and how is the prognosis?
Management depends on the cause. Prognosis is generally favorable if the underlying cause can be reversed.
In cases of hemorrhagic choroidal detachment what is the appropriate management?
Prompt surgical drainage required in hemorrhagic cases with severe pain or extremely elevated IOP.
What medication is commonly associated with bilateral, acute angle closure and what causes it?
Topamax- is a sulfa based medicine where the patient has an allergic reaction leading to inflammation of the choroid and later bilateral choroidal effusion
True or false- in the case of acute angle closure secondary to Topamax use, Pilocarpine should be instilled and a peripheral iridotomy should be performed.
False- there is NO indication for a peripheral iridotomy or miotics because there is no relative pupil block.
What is the prognosis of acute angle closure secondary to Topamax use?
Most cases resolve within days/weeks without permanent damage.
What condition refers to an idiopathic choroidal detachment along with an exudative RD for no other reason?
Uveal Effusion syndrome
What demographic does uveal effusion syndrome typically affect?
It typically affects hyperopic middle-aged men.
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