Grand Rounds - PowerPoint PPT Presentation

Loading...

PPT – Grand Rounds PowerPoint presentation | free to download - id: 10ee2f-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Grand Rounds

Description:

BLD and typical drusen occur frequently in macular region ... Stereioscopic atlas of macular diseases: diagnosis and treatment (4th ed. ... – PowerPoint PPT presentation

Number of Views:43
Avg rating:3.0/5.0
Slides: 28
Provided by: hpcus625
Category:
Tags: grand | macular | rounds

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Grand Rounds


1
Grand Rounds
  • Marc Moore, MD
  • June 2, 2007

2
HPI
  • 33 yo wf was shopping 2 months prior when she
    noticed blinking lights OU lasting 30 minutes.
    She has had no flashes since. Occasional floater
    OD. Seen by ophthalmologist who recommended
    further evaluation by retina due to exam findings.

3
History
  • MedHx migraines, asthma, s/p BTL
  • OcHx none
  • Meds Advair, Albuterol, Flaxseed oil, MV
  • All Vioxx, Paxil, Ketek, Levaquin, Macrodantin
  • SocHx no tob, occ EtOH
  • FamHx grandfather?blindness from unknown cause
  • ROS negative

4
Exam
  • VA 20/20 OD
  • 20/20 OS
  • Mot full OU
  • CVF full OU
  • TD 16 OD, 17 OS
  • Pupils no RAPD

5
Exam
  • Lids quiet OU
  • Conj quiet OU
  • K clear OU
  • AC D Q OU
  • Iris no NVI OU
  • Lens clear OU
  • Ant Vit quiet OU

6
Fundus Photo OD
7
Fundus Photo OS
8
Differential
  • Early-onset ARMD
  • Cuticular / Basal laminar drusen
  • Fundus flavimaculatus
  • Fundus albipunctatus
  • Familial Drusen
  • North Carolina macular dystrophy
  • Malattia Leventinese
  • Doyne honeycomb retinal dystrophy
  • Retinitis punctata albescens
  • White Dot Syndromes

9
(No Transcript)
10
Differential
  • Early-onset ARMD
  • Cuticular / Basal laminar drusen
  • Fundus flavimaculatus
  • Fundus albipunctatus
  • Familial Drusen
  • North Carolina macular dystrophy
  • Malattia Leventinese
  • Doyne honeycomb retinal dystrophy
  • Retinitis punctata albescens
  • White Dot Syndromes

11
Basal Laminar Drusen
  • In 1977, Dr. Gass described a syndrome
    characterized by the funduscopic findings
  • innumerable, small, uniform sized, discretely
    round, slightly raised, yellow, subretinal
    lesions that fluoresced discretely during early
    arteriovenous phase to give a beautiful
    stars-in-the-sky appearance in the fundus

12
Basal Laminar Drusen
  • Occur more commonly in women
  • Occur in relatively young patients and those with
    a highly pigmented fundus
  • Drusen are usually 25 to 75 µm in size
  • Nodular thickening of basement membrane of RPE
  • Likely the product of a dystrophic disease of the
    pigment epithelium

13
(No Transcript)
14
BLD differs from ARMD
  1. Visual symptoms occur less frequently and usually
    detected 5-10 years earlier
  2. Rate of visual loss after onset of symptoms is
    slower
  3. Spontaneous improvement in acuity is more likely
    to occur
  4. Development of geographic atrophy is higher
  5. CNVM and large exudative detachments of RPE
    probably lower
  6. Prognosis for retention of central vision is
    better

15
Complications of BLD
  • Gass et al (1985) studied 41 pt with BLD
  • 17 of 41 developed visual loss caused by
    vitelliform exudative retinal detachment in the
    macula of one or both eyes
  • Spontaneous resolution of the detachment and
    retention of good visual acuity occurred
    frequently

16
Vitelliform Macular Detachment with BLD
  • 56 yo female diagnosed with BLD
  • Over 5 yr period, progression of vitelliform
    macular detachment that gave way to geographic
    atrophy
  • Pt unable to read without low-vision aids

17
Vitelliform Macular Detachment with BLD
18
Complications of BLD
  • Cohen et al analyzed 19 pts with BLD
    vitelliform macular detachment
  • Mean final VA 20/50
  • 16 of 38 eyes were 20/40 or better
  • 12 of 19 pts were 20/40 or better in at least one
    eye
  • CNVM observed in 12 out of 38 eyes (31)
  • 2/3 with CNVM at time of presentation (? referral
    bias)
  • Recommend close follow-up

19
Type II Mesangiocapillary glomerulonephritis
(MCGN)
  • Renal disorder with proliferation of mesangial
    cells alterations in BM of the glomerulus
  • Type II with electron-dense ribbonlike deposits
  • Associated with hypocomplementemia, partial
    lipodystrophy and higher incidence of diabetes

20
Type II Mesangiocapillary glomerulonephritis
(MCGN)
  • BLD and typical drusen occur frequently in
    macular region
  • Deposits increase in number and size with age
  • Occur more frequently in pts with lipodystrophy
  • Most pts asymptomatic although some may develop
    CNVM at early age

21
Basal Laminar Drusen vs. ARMD Drusen
  • Russell et al (2000) immunohisto-chemically
    examined an enucleated eye with BLD vs. 2 eyes
    with ARMD
  • Like ARMD, BLD deposits are located between RPE
    and Bruchs membrane
  • Basal laminar drusen were bound by the same
    markers as ARMD drusen

22
(No Transcript)
23
Basal Laminar Drusen vs. ARMD Drusen
  • BL drusen were not labeled by basal laminae
    specific antibodies
  • Same carbohydrate and protein composition in both
  • Conclusion BL drusen are not composed of nodular
    thickenings of the BM of RPE
  • Suggest early adult onset, grouped drusen or
    Gass syndrome

24
(No Transcript)
25
Management
  • No formal guidelines for management of BLD
  • No evidence that vitamins are effective
  • Most authors advocate yearly exams, advising pts
    to be seen earlier if they experience visual
    changes
  • No recommended injection or laser treatment to
    prevent complications

26
Conclusions
  • There is still debate as to the precise
    composition and location of BLD
  • Pts with Type II MCGN frequently have BLD and
    should have ophthalmologic evaluation after
    diagnosis
  • Pts with BLD must be monitored for complications
    such as CNVM and exudative detachments

27
References
  • Albert DM, Jakobiec FA. Principles and Practice
    of Ophthalmology (2nd ed.). W.B. Saunders Co,
    Philadelphia 2000.
  • Cohen SY, Meunier I, Soubrane G, Glacet-Bernard
    A, Coscas GJ. Visual function and course of
    basal laminar drusen combined with vitelliform
    macular detachment. Br J of Ophthalmol 78 (1994)
    pp 437-440.
  • Gass JD. Stereioscopic atlas of macular diseases
    diagnosis and treatment (4th ed.), Mosby, St
    Louis 1997.
  • Gass JD, Jallow S, and Davis B. Adult
    vitelliform macular detachment occurring in
    patients with basal laminar drusen. Am J
    Ophthalmol 99 (1985). pp.445-459.
  • Meunier I, Cohen SY, Debibie C, Quentel G.
    Five-Year Evolution of Basal Laminar Drusen
    Combined With Vitelliform Macular Detachment.
    Arch Ophthalmol 2004 1221566.
  • Russell SR, Mullins RF, Schneider BL, Hageman GS.
    Location, substructure, and composition of basal
    laminar drusen compared with drusen associated
    with aging and age-related macular degeneration.
    Am J Ophthalmol. 2000 Feb129(2)205-14.
About PowerShow.com