By Adam H Rogers
This name within the fast prognosis in Ophthalmology sequence provides a wealth of full-color photographs - besides differential diagnoses - in side-by-side web page layouts to aid you in settling on an entire diversity of retinal issues. A templated structure expedites entry to the counsel you must diagnose the most typical retinal stipulations - from uncomplicated to complicated - encountered in practice.Coverage of state-of-the-art issues together with lucentis treatment for rainy ARMD, Avastin treatment for macular sickness, and counsel on OCT imaging, assist you continue your wisdom as much as date.Hundreds of full-color photographs current stipulations as they found in genuine life.Common diagnostic pitfalls speak about what to seem out for while creating a tricky prognosis. A templated, color-coded structure and differential analysis containers for every assist you make speedy, actual scientific decisions.A specialise in the most typical stipulations encountered in perform helps you to successfully formulate remedies and referrals.SERIES EDITORS: Jay S. Duker, MD, Director, New England Eye middle, Vitreoretinal ailments and surgical procedure carrier; Director, Pediatric Retinal Referral heart, Uveitis & Immunology provider; Professor and Chair of Ophthalmology, Tufts collage university of drugs, Boston, MA and Marian S. Macsai, MD, leader, department of Ophthalmology, Evanston Northwestern Healthcare; Professor and Vice-Chair of the dep. of Ophthalmology, Feinberg tuition of medication, Northwestern college, MI
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Additional resources for Rapid Diagnosis in Ophthalmology Series: Retina
Radiation Retinopathy A 53 Sickle Cell Retinopathy Key Facts • Chronic retinal vascular changes induced by genetic abnormalities in hemoglobin production • Intravascular sickling, thrombosis, hemolysis, and hemostasis occur from altered red blood cells leading to the ocular changes • Proliferative sickle cell retinopathy occurs most often in Hb SC disease followed by Sickle cell thalassemmia (SThal) and Sickle cell disease (HbSS) • Visual deﬁcits occur secondary to macular ischemia • Severity of systemic illness does not directly correlate with ocular manifestations • Bilateral Clinical Findings SECTION 3 • Vascular Obstructions • Arteriolar occlusion • Salmon patch hemorrhage (intraretinal hemorrhage after peripheral retinal arterial occlusion) • Refractile deposits (hemosiderin left from reabsorbed hemorrhage) • Black sunburst lesions (retinal pigment epithelium hyperplasia) • Small red spots on optic disc • Angioid streaks (6% of AS and SS disease) • Peripheral retinal neovascularization (sea fan) • Vitreous hemorrhage • Traction and rhegmatogenous retinal detachment Ancillary Testing • Sickle cell solubility test (sickle cell preparation) is a screening tool to identify the presence of hemoglobin S; however, it does not differentiate between the heterozygote (Hb AS) and homozygote (Hb SS) states • Hemoglobin electrophoresis is a deﬁnitive test done after a positive sickle cell solubility test • Fluorescein angiography to evaluate macular circulation and peripheral retinal neovascularization • Ultrasound when vitreous hemorrhage prevents visualization of retina Differential Diagnosis • • • • • • • • • • • • 54 Diabetic retinopathy Retinopathy of prematurity Familial exudative vitreoretinopathy Central retinal vein occlusion Branch retinal vein occlusion Ocular ischemic syndrome Branch retinal artery occlusion Hyperviscosity syndromes Carotid cavernous ﬁstula Posterior uveitis Pars planitis Rhegmatogenous retinal detachment A B Fig.
29 Section 3 Vascular Obstructions Branch Retinal Vein Occlusion 32 Central Retinal Vein Occlusion 36 Branch Retinal Artery Occlusion 38 Cilioretinal Artery Occlusion 40 Central Retinal Artery Obstruction 42 Coats Disease 46 Idiopathic Juxtafoveal Telangiectasia 50 Radiation Retinopathy 52 Sickle Cell Retinopathy 54 Hypertensive Retinopathy 58 Ocular Ischemic Syndrome 62 Retinal Arterial Macroaneurysm 64 Purtscher Retinopathy 66 Terson Syndrome 68 HIV Retinopathy 70 Hematologic Disorders 72 Branch Retinal Vein Occlusion Key Facts • • • • • • Common cause of acute visual loss or visual ﬁeld deﬁcit Typically unilateral but may be bilateral in 5–10% of patients Men and women equally affected Most often occurs in elderly persons More common than central retinal vein occlusion Hypertension and arteriosclerosis are the major associations Clinical Findings SECTION 3 • Vascular Obstructions 32 • Decreased visual acuity • Visual ﬁeld defect corresponding to area of venous occlusion • Intraretinal hemorrhage in the distribution along the obstructed retinal vein, with the apex of the hemorrhage at an arteriovenous crossing • Macular edema • Capillary non-perfusion and macular ischemia • Retinal neovascularization • Vitreous hemorrhage • Collateral vessel formation in chronic disease Ancillary Testing • Fluorescein angiography (FA) to evaluate capillary non-perfusion and areas of retinal ischemia • Optical coherence tomography to evaluate and monitor macular edema Differential Diagnosis • • • • • Diabetic retinopathy Hypertensive retinopathy Idiopathic juxtafoveal telangiectasia Radiation retinopathy Ocular ischemic syndrome Treatment • Laser treatment is guided by the Branch Retinal Vein Occlusion Study Group • Grid laser for macular edema: • apply to eyes with 20/40 or worse vision for ≥3 months with intact foveal circulation • delay treatment if the macular hemorrhage is too dense to enable photocoagulation or evaluate retinal circulation on FA • withhold if decreased vision is due to capillary non-perfusion • Panretinal photocoagulation to the peripheral non-perfused retina as visualized on FA when retinal neovascularization is present • Intravitreal corticosteroids in eyes with macular edema, either as a primary treatment or in eyes refractory to grid laser photocoagulation • Intravitreal anti–vascular endothelial growth factor (VEGF) therapy for macular edema, either as a primary treatment or in eyes refractory to grid laser photocoagulation • Sheathotomy during pars plana vitrectomy to sever the common sheath shared by the arteriole and vein at the level of the obstruction to free the artery from compressing the vein B A Fig.
Hypertensive Retinopathy Fig. 30 Severe hypertensive retinopathy in a woman with advanced renal failure. Fig. 31 Multiple cotton wool spots and narrowing of arterioles in an eye with hypertensive retinopathy. 59 Hypertensive Retinopathy (Continued) SECTION 3 • Vascular Obstructions A B Fig. 32 (A) Right and (B) left eye of a woman with pregnancy-induced hypertension from pre-eclampsia. Focal yellow choroidal lesions are visible superior to the optic nerve in the right and along the superior temporal arcade in the left eye.