Mohamed A.Zaher
MSc
Anatomy:
 Gross anatomy:
Microscopic
anatomy:
Physiology:
To brain
Rods sense
brightness
Cones sense
color
The retina, in the back
of your eye, has cells
that are sensitive to
light. They connect
directly to your brain
 Function:
1) Retinal pigment epithelium: nutrition, vit A
metabolism, heat sink, …
2) Rods: dim illumination
3) Cones: bright illumination, color vision
•
Blood supply:
Central Retinal Artery
Choriocapillaris
How to examine the retina
Structure:
 Indirect ophthalmoscope
 Direct ophthalmoscope
 Slit lamp with auxiliary lenses e.g. Volk 90 D
Function:
• Visual acuity e.g. Snellen acuity
• Color vision e.g. Ishihara color plates
• Field of vision (perimetry)
How to investigate the retina
Fundus Flourescein Angiography
 Principle:
 Optical coherence tomography (OCT)
 B scan Ultrasonography
 Electroretinography (ERG):
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
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??
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
L: Lamina cribrosa
C : Central retinal
Vessels
N: Nerve fiber layer
S: Sclera
A: nerve bundle
G: Glial tissue
Ischemic CRVO
Fundus Fluorescein
Angiography of the left eye
showing:
•Areas of retinal ishemia
•NVDs
•NVEs
3) Retinal arteriosclerosis:
changes in Artery
Vein
A-V crossing
Retinopatheies:
1) Diabetic Retinopathy:
• Risk Factors
• Pathophysiology: microvascular leakage
occlusion
 Stages:
1- Non proliferative DR: microaneurysms
edema
hard exudate
dot-blot hemorrhage
NPDR
Fundus photograph of Left
eye showing:
retinal hemorrhages
microaneurysms
2- Pre proliferative DR:
IRMA – venous beading – increase hge – cotton wool
spots
IRMA
3- proliferative DR:
NVD – NVE -NVI
PDR
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NVI
 Diabetic maculopathy:
ischemia - edema
Diabetic maculopathy
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 Complications:
haemorrhage
Retinitis proliferans
Tractional RD
• Treatment:
- control DM
- IV injection (Avastin)
- Laser
photocoagulation
- Vitrectomy
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:
1) CRAO
2) Retrobulbar neuritis
3) Hysterical blindness
4) RD
 In the above case, the most useful investigation is:
1) Ultrasonography
2) OCT
3) FFA
4) VEP
 Central retinal edema is NOT present in:
1) CRAO
2) CRVO
3) Commotio retinae
4) Macular hypoplasia
 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:
1) NPDR
2) PDR
3) Left CRVO
4) Left CRAO
 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
 Flourescein Angiography is NOT of diagnostic value
in:
1) Diabetic retinopathy
2) Diabetic maculopathy
3) BRAO
4) Rhegmatogenous RD
 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?
1) X ray of the orbit
2) Ultrasonography
3) ERG
4) FFA
 The presence of cotton wool patches denotes the
following EXCEPT:
1) Retinal ischemia
2) Infarction in the nerve fiber layer
3) Active exudation from a retinal microaneurysm
4) PDR
 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:
1) Grid pattern photocoagulation
2) Focal photocoagulation
3) PRP
4) PRP and focal photocoagulation
 A hypertensive patient developed an acute attack of
marked diminution of vision. On fundus exam all of
the following are present EXCEPT:
1) Macular star
2) Macular hole
3) RAO
4) RVO
 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:
1) Tonometry
2) Angle of AC
3) Fundus exam
4) Field of vision
 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:
1) Β blocker
2) Carbonic anhydrase inhibitor
3) Pilocarpine
4) Non steroidal anti inflammatory drops
2) Hypertensive Retinopathies:
- Acute
- Chronic
Retinal Degeneration
1) Retinitis Pigmentosa:
- Aetiology
- symptoms: rods maily
- signs
- investigations: ERG – Visual
field
- association: cataract,
glaucoma
- treatment
2) Tay Sachs disease (Amaurotic Family Idiocy):
Retinal Detachment
 Definition
 Types:
- Rhegmatogenous
- Tracional
- Exudative
 Symptoms:
retinal symptoms
 Signs
 Investigations:
U/S
• Prophylactic treatment:
Argon laser
Cryotherapy
 Treatment:
Scleral Buckling
Vitrectomy
Pneumatic retinopexy
Thank you