Posterior Segment Update

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1 Posterior Segment Update Featured Speaker: Dr. Kyle Cheatham, FAAO, DIP ABO DISCLOSURE STATEMENT We have no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.

2 Q A Which of the Retinal vessels following represents the TIGHTEST Macula vitreous attachment to the sensory retina? Optic nerve head Ora serrata

3 Q A Which of the Retinal vessels following represents the TIGHTEST Macula vitreous attachment to the sensory retina? Optic nerve head Ora serrata

4 VITREOUS ATTACHMENTS ORA SERRATA BACK OF LENS OPTIC NERVE MACULA RETINA VESSELS MACULAR HOLE ERM VMT VMA

5 Vitreous Review

6 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE SUBRETINAL CNMV ( NET )

7 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE SUBRETINAL CNMV ( NET ) DIABETES ROP VEIN OCCLUSION OIS SICKLE CELL ANEMIA

8 65 year old DM

9 Q A This patient is at risk Vitreous hemorrhage for all of the following EXCEPT? Preretinal hemorrhage Tractional retinal detachment Choroidal Neovascular Membrane

10 Q A This patient is at risk Vitreous hemorrhage for all of the following EXCEPT? Preretinal hemorrhage Tractional retinal detachment Choroidal Neovascular Membrane

11 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE SUBRETINAL CNMV ( NET ) DIABETES ROP VEIN OCCLUSION OIS SICKLE CELL ANEMIA

12 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE DIABETES TRACTIONAL RD ROP VEIN OCCLUSION OIS SICKLE CELL ANEMIA THREATS! PRERETINAL HEM VITREOUS HEM

13 Q A Which of the Diabetes following does NOT cause proliferative Vein occlusions retinopathy? Retinopathy of prematurity ARMD

14 Q A Which of the Diabetes following does NOT cause proliferative Vein occlusions retinopathy? Retinopathy of prematurity ARMD

15 DIABETIC RETINOPATHY NONPROLIFERATIVE (NPDR) PROLIFERATIVE (PDR) MACULAR DISEASE PRERETINAL VITREOUS HEMORRHAGES TRACTIONAL RETINAL DETACHMENTS MACULAR EDEMA MACULAR ISCHEMIA NEOVASCULAR CLAUCOMA

16 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE SUBRETINAL CNMV ( NET ) DIABETES ROP VEIN OCCLUSION OIS SICKLE CELL ANEMIA

17 75 year old / DM and HTN

18 Q A What is the MOST Cholesterol plaque common cause of this condition? Heart valve plaque Thrombus Sickle Cell Anemia

19 Q A What is the MOST Cholesterol plaque common cause of this condition? Heart valve plaque Thrombus Sickle Cell Anemia

20 Q A Which of the ARMD following does NOT result in choroidal Lacquer cracks neovascular membrane Histoplasmosis formation? Toxoplasmosis

21 Q A Which of the ARMD following does NOT result in choroidal Lacquer cracks neovascular membrane Histoplasmosis formation? Toxoplasmosis

22 NEOVASCULARIZATION PRERETINAL PROLIFERATIVE SUBRETINAL CNMV ( NET ) CHOROIDAL RUPTURE HISTOPLASMOSIS BEST S DISEASE ANGIOID STREAKS LACQUER CRACKS AMD

23 NEOVASCULARIZATION SUBRETINAL CNMV ( NET ) SUB-RPE HEMORRHAGE CHOROIDAL RUPTURE SUB-RPE DETACHMENT SENSORY RETINAL HEMORRHAGE SENSORY RETINAL DETACHMENT THREATS! HISTOPLASMOSIS BEST S DISEASE ANGIOID STREAKS LACQUER CRACKS AMD

24 Wet AMD

25 Q A What type of net is visible in this patient? Pigment epithelial detachment (PED) Sub-RPE detachment Sensory retinal hemorrhage Sub-RPE hemorrhage

26 Q A What type of net is visible in this patient? Pigment epithelial detachment (PED) Sub-RPE detachment Sensory retinal hemorrhage Sub-RPE hemorrhage

27 What type of CNVM ( net )?

28 Types of Detachments

29 MACULAR DEGENERATION NON-EXUDATIVE (DRY) EXUDATIVE (WET) SICK RPE SUB-RPE HEMORRHAGE SUB-RPE DETACHMENT GEOGRAPHIC ATROPHY DRUSENOID PED SENSORY RETINAL HEMORRHAGE SENSORY RETINAL DETACHMENT

30 75 year old AA / HTN / High cholesterol / Smoker

31 Q A Which of the Hard drusen following is a risk factor for progression High cholesterol to exudative AMD in this patient? Focal hyperpigmentation African American race

32 Q A Which of the Hard drusen following is a risk factor for progression High cholesterol to exudative AMD in this patient? Focal hyperpigmentation African American race

33 MACULAR DEGENERATION NON-EXUDATIVE (DRY) BIG 4 EXUDATIVE (WET) SICK RPE SUB-RPE HEMORRHAGE SUB-RPE DETACHMENT GEOGRAPHIC ATROPHY DRUSENOID PED SENSORY RETINAL HEMORRHAGE SENSORY RETINAL DETACHMENT

34 30 year-old with 20/30 BCVA OD

35 Q A What is the MOST BRAO likely diagnosis? Sickle Cell Anemia Histoplasmosis Toxoplasmosis

36 Q A What is the MOST BRAO likely diagnosis? Sickle Cell Anemia Histoplasmosis Toxoplasmosis

37 Histoplasmosis Most common in the Ohio-Mississippi River Valley.

38 Histoplasmosis Most common in the Ohio-Mississippi River Valley. Caused by a fungus that grows in soil and material contaminated with bird or bat droppings.

39 Histoplasmosis Most common in the Ohio-Mississippi River Valley. Caused by a fungus that grows in soil and material contaminated with bird or bat droppings. Asymptomatic unless maculopathy develops; the earliest symptom is metamorphopsia.

40 Histoplasmosis Most common in the Ohio-Mississippi River Valley. Caused by a fungus that grows in soil and material contaminated with bird or bat droppings. Asymptomatic unless maculopathy develops; the earliest symptom is metamorphopsia. Starts in the CHOROID and can spill-over into the retina, but never the vitreous!

41 Histoplasmosis Most common in the Ohio-Mississippi River Valley. Caused by a fungus that grows in soil and material contaminated with bird or bat droppings. Asymptomatic unless maculopathy develops; the earliest symptom is metamorphopsia. Starts in the CHOROID and can spill-over into the retina, but never the vitreous! CNVM is a late manifestation; if it occurs, it is most likely to happen between the ages of 20 and 45.

42 NEOVASCULARIZATION SUBRETINAL CNMV ( NET ) SUB-RPE HEMORRHAGE CHOROIDAL RUPTURE SUB-RPE DETACHMENT SENSORY RETINAL HEMORRHAGE SENSORY RETINAL DETACHMENT THREATS! HISTOPLASMOSIS BEST S DISEASE ANGIOID STREAKS LACQUER CRACKS AMD

43 35 year old / BCVA: 20/200 OD, 20/400 OS

44 Q A What is the MOST Best s disease likely diagnosis? Myopic degeneration Histoplasmosis Angioid Streaks

45 Q A What is the MOST Best s disease likely diagnosis? Myopic degeneration Histoplasmosis Angioid Streaks

46 Angioid Streaks 50% idiopathic / Main known cause is pseudoxanthoma elasticum.

47 Angioid Streaks 50% idiopathic / Main known cause is pseudoxanthoma elasticum. May be asymptomatic or have profound vision loss from choroidal neovascularization (CNVM). 70% of patients will eventually have some form of vision loss.

48 Angioid Streaks 50% idiopathic / Main known cause is pseudoxanthoma elasticum. May be asymptomatic or have profound vision loss from choroidal neovascularization (CNVM). 70% of patients will eventually have some form of vision loss. Classic spoke-like (from the optic disc) red/orange or brown lines within the elastic core of Bruch s membrane.

49 VES Sport 4x Telescope DISCLOSURE STATEMENT We have no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.

50 35 year old / BCVA: 20/200 OD, 20/400 OS

51 27 year old / BCVA: 20/30 OD, 20/25 OS

52 Best s Disease The age of onset varies but the condition classically presents in early childhood (5-10 years old) from AD inheritance. The majority of cases are detected with little or no patient symptoms (75% better than 20/40) 5 stages stage 5 occurs around age 50 and is characterized by presence of CNVM.

53 kmkupdate.com

54 Posterior Segment Update Featured Speaker: Dr. Kyle Cheatham, FAAO, DIP ABO DISCLOSURE STATEMENT We have no direct financial or proprietary interest in any companies, products or services mentioned in this presentation.

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