Board Certified Ophthalmologist FREE Retina and Vitreous Disorders Questions and Answers 2 — Questions and Answers
Question 1: A 62-year-old diabetic patient presents with neovascularization of the disc (NVD) covering more than one-third of the disc area. According to the Early Treatment Diabetic Retinopathy Study (ETDRS), what is the most appropriate next step?
- Observation with follow-up in 3 months
- Intravitreal anti-VEGF monotherapy
- Prompt panretinal photocoagulation (Correct answer)
- Pars plana vitrectomy
Correct answer: Prompt panretinal photocoagulation
The ETDRS established that high-risk proliferative diabetic retinopathy with NVD exceeding one-third disc area warrants prompt panretinal photocoagulation to reduce the risk of severe vision loss.
Question 2: Which finding on optical coherence tomography (OCT) is most characteristic of central serous chorioretinopathy (CSC)?
- Intraretinal cystic spaces with petaloid pattern
- Subretinal fluid with a neurosensory detachment and possible pigment epithelial detachment (Correct answer)
- Hyperreflective foci within the outer nuclear layer
- Disruption of the ellipsoid zone with subretinal fibrosis
Correct answer: Subretinal fluid with a neurosensory detachment and possible pigment epithelial detachment
CSC classically demonstrates a dome-shaped neurosensory detachment with subretinal fluid accumulation, often accompanied by a pigment epithelial detachment on OCT.
Question 3: A patient with a history of retinal detachment repair presents with decreased vision and an epiretinal membrane causing significant macular distortion. Which surgical intervention is most appropriate?
- Scleral buckle revision
- Pneumatic retinopexy
- Pars plana vitrectomy with membrane peeling (Correct answer)
- Intravitreal corticosteroid injection
Correct answer: Pars plana vitrectomy with membrane peeling
Pars plana vitrectomy with membrane peeling is the standard surgical treatment for visually significant epiretinal membranes causing macular distortion.
Question 4: What is the most common cause of vitreous hemorrhage in adults over age 50?
- Posterior vitreous detachment with retinal tear (Correct answer)
- Trauma
- Terson syndrome
- Valsalva retinopathy
Correct answer: Posterior vitreous detachment with retinal tear
Posterior vitreous detachment causing a retinal tear with disruption of a bridging retinal vessel is the most common etiology of vitreous hemorrhage in adults over 50.
Question 5: A 45-year-old woman presents with sudden painless vision loss and fundoscopy reveals a cherry-red spot at the macula with surrounding retinal whitening. Which condition is most likely?
- Central retinal vein occlusion
- Anterior ischemic optic neuropathy
- Central retinal artery occlusion (Correct answer)
- Optic neuritis
Correct answer: Central retinal artery occlusion
A cherry-red spot with surrounding pale, edematous retina is the hallmark fundoscopic finding of central retinal artery occlusion due to inner retinal ischemia.
Question 6: In a patient with wet age-related macular degeneration, which OCT finding most strongly indicates active choroidal neovascularization requiring treatment?
- Drusen without subretinal fluid
- Geographic atrophy of the RPE
- Subretinal and intraretinal fluid with pigment epithelial detachment (Correct answer)
- Vitreomacular traction without fluid
Correct answer: Subretinal and intraretinal fluid with pigment epithelial detachment
The presence of subretinal fluid, intraretinal fluid, or pigment epithelial detachment on OCT indicates active exudation from choroidal neovascularization requiring anti-VEGF therapy.
Board Certified Ophthalmologist FREE Retina and Vitreous Disorders Questions and Answers 2
A 62-year-old diabetic patient presents with neovascularization of the disc (NVD) covering more than one-third of the disc area.
According to the Early Treatment Diabetic Retinopathy Study (ETDRS), what is the most appropriate next step?