OPH: SAMPLEX BASED RATIO

CASE QUIZ OPHTHALMOLOGY

CASE QUIZ
Case 5 and 6 NOV 25 2021

CASE QUIZ
QUESTION ANSWER RATIONALE
1. Trauma is an important predisposing factor to True Retinal Detachment
retinal detachment. ● Risk Factors
→ Age
■ 45-65 years old age group (Number 1)
■ Cause is usually posterior vitreous detachment
→ Myopia
→ Cataract surgery
■ 1% risk, even if uncomplicated
■ Always disclose to patient
■ May develop earlier posterior vitreous detachment
→ Ocular trauma
→ Lifetime risk: 1:300
→ Incidence: 1:10,000/year
OPH.1.10.RETINA AND RETINAL DISORDERS
2. In rhegmatogenous retinal detachment, a retinal True Retinal detachment is classified under “Peripheral disorders of the retina”
tear is present, usually located in the retinal • Rhegmatogenous Retinal Detachment: can still have 20/20 vision if it does not affect the visual axis,
periphery. since the detachment starts peripherally
Retinal detachment pathology is in the far periphery and requires indirect ophthalmoscopy or wide-field retinal
photography to visualize.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 26, 2021.)
3. Screening for this condition entails an False Retinal detachment pathology is in the far periphery, and requires indirect ophthalmoscopy or wide-field
examination of the retina using a direct retinal photography to visualize.
ophthalmoscope.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 2 6, 2021.)

Rhegmatogenous Retinal Detachment

● Binocular indirect ophthalmoscopy with scleral depression/slitlamp examination with a handheld contact
biomicroscopy lens
● Reveals elevation of the translucent detached sensory retina with one or more full-thickness sensory retinal
breaks
→ Horseshoe tear in the superotemporal quadrant
→ Holes in the temporal quadrant
→ Retinal dialysis in the inferotemporal quadrant
→ Scleral depression – allows us to examine the periphery
OPH.1.10.RETINA AND RETINAL DISORDERS
4. In retinal detachment, separation of the layers of True ● Retinal pigment epithelium
the retina occurs between the inner layers of the → Gives orange color of the retina
retina and the retinal pigment epithelium. → Area of RPE + rods & cones (photoreceptors) – where separation occurs in retinal detachment
● Retinal Detachment
→ Separation of neurosensory retina from underlying RPE
■ Sensory retina photoreceptors
OPH.1.10.RETINA AND RETINAL DISORDERS
A-TG5
5. Retinal detachment involving the macula should True The visual results of surgery for rhegmatogenous retinal detachment primarily depend on the preoperative
be treated urgently. (Bonus) status of the macula. If the macula has been detached, recovery of central vision is usually incomplete. Thus,
surgery should be performed urgently if the macula is still attached. Once the macula is detached, delay in
surgery for up to 1 week does not adversely influence visual outcome.
Vaughan & Asbury’s General Ophthalmology p. 210
6. The visual field exam in the case with retinal False In case discussion 6, the confrontational visual field exam was as follows:
detachment was normal. ● OD central, inferior, and nasal field deficits
● OS full to finger counting
7. There are no external eye signs in retinal True Regardless of the cause, patients with retinal detachments present with painless loss of vision in the affected
detachment. eye. In most cases, the patient will experience symptoms of posterior vitreous detachment as well, including
floaters and flashes of light. However, retinal detachments can occasionally be asymptomatic.
Arroyo, J.G. (2020). Retinal Detachment. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on November 26, 2021.)
8. A surgery for retinal detachment is scleral True Scleral buckling
buckling. ● Maintains the retina in position, while the chorioretinal adhesion forms, by indenting the sclera with a sutured
explant in the region of the retinal break
● Relieves vitreo-retinal traction and displaces the subretinal fluid away from the retinal break
● Success rate is 92-94%
OPH.1.10.RETINA AND RETINAL DISORDERS
9. Central Visual Acuity may be unaffected in True Symptoms of impending retinal detachment
peripheral retinal detachments. ● First symptom: floaters and flashes of light (signs of posterior segment problem)
● Sudden loss of vision (curtain vision)
OPH.1.10.RETINA AND RETINAL DISORDERS
10. Peripheral retinal detachments may be observed False Treatment of Rhegmatogenous Retinal Detachment
only. ● ALWAYS SURGICAL
● Examples are: Pneumatic retinopexy, laser cryotherapy, Scleral bucking, Pars plana vitrectomy

OPH.1.10.RETINA AND RETINAL DISORDERS

11. In our case, RAPD is detected in OS. This False In case discussion 5, (+) RAPD OS: This is indicative of asymmetric optic nerve disease or damage. It does
signifies the presence of cataract in that eye not signify cataract.
OPH.2.10.CASE DISCUSSION 5
12. In optic neuritis, treatment is oral low dose False Treatment of Optic Neuritis: Steroid Therapy
steroids ● IV methylprednisolone led to more rapid recovery of vision, but the final outcome was no better than
with oral prednisone alone or with placebo similar results is earlier and later studies that faster recovery is
the sole benefit of steroid treatment.
● Bioequivalence: 1250mg/kg prednisone
● Established role for high-dose IV corticosteroid therapy in the treatment of typical optic neuritis
● Low dose oral prednisone alone had higher rates of new attacks of optic neuritis (recurrence)
OPH.2.10.CASE DISCUSSION 5
13. Observation is acceptable treatment for optic True Optic neuritis (ON) is a self-limiting condition caused by inflammation-driven demyelination process affecting
neuritis the optic nerve. Main clinical features are sudden, unilateral worsening of visual acuity, colour vision
disturbance, visual field defects and motion-induced ocular pain. Spontaneous recovery appears usually
within up to 8 weeks.
Gryzbowski, A. and Pieniqzek, M. (2013). Treatment of Optic Neuritis. European Opthalmic Review,7(1):52-5
: http://doi.org/10.17925/EOR.2013.07.01.52
14. If there no pain in our patient, this is considered True Typical optic neuritis has pain, loses vision over 12 days then gets better, and is common in young patients so
unusual, atypical. if the pattern does not present like this, it’s atypical
OPH.2.06.NEURO-OPHTHALMOLOGY

A-TG5
15. Multiple sclerosis is very common in the False Epidemiology of multiple sclerosis:
Philippines ● US: 100-200/100,000
● Asia: 1-5/100,000
OPH.2.06.NEURO-OPHTHALMOLOGY
16. Most adult cases of optic neuritis have swollen False Profile of patients with optic neuritis
disc. ● 65% presents with a normal disc
● 35% presents with swollen disc which is more common in children
OPH.2.06.NEURO-OPHTHALMOLOGY
17. In optic neuritis with hard exudates in macula, False Neuroretinitis, neuromyelitis optica, chronic recurrent immune optic neuropathy, and optic nerve involvement
this is most likely associated with multiple in other autoimmune diseases are the most common atypical type of optic neuritis. Only neuroretinitis
sclerosis. can be diagnosed early on the basis of the macular findings.

In neuroretinitis, inflammation spreads from the optic nerve to the retina. This disc is very swollen, and, when
the symptoms are most severe, a stellate figure composed of hard exudates is seen in the macula.
Wilhelm, H., & Schabet, M. (2015). The Diagnosis and Treatment of Optic Neuritis. Deutsches Arzteblatt international, 112(37), 616–
626. https://doi.org/10.3238/arztebl.2015.0616
18. MRI is indicated in optic neuritis to determine True Other ancillary tests for optic neuritis (irrespective of etiology):
chance of developing multiple sclerosis. ● Magnetic Resonance Imaging (MRI)
→ Optic nerve MRI
■ Gadolinium enhancement, increased signal and occasionally, swelling of the affected nerve
→ Brain MRI
■ Cerebral brainstem and/or cerebellar white matter lesions
■ Periventricular white matter lesions → predisposition to multiple sclerosis
■ White matter abnormalities → most valuable predictor for the development of MS
● Visual Evoked Potential (VEP)
→ Assessment of the alteration in visual acuity due to demyelination
● Optical Coherence Tomography
→ Measures the thickness of the retinal nerve fiber layer and determine the extent of axonal atrophy
OPH.2.10.CASE DISCUSSION 5
19. MRI findings consistent with multiple sclerosis True Brain MRI
are periventricular white matter lesions. ● Cerebral brainstem and/or cerebellar white matter lesions
● Periventricular white matter lesions → predisposition to multiple sclerosis
● White matter abnormalities → most valuable predictor for the development of MS
OPH.2.10.CASE DISCUSSION 5
20. Optic neuritis symptoms include decreased color True Common clinical features of typical optic neuritis:
vision. ● Cardinal symptom: subacute loss of vision developing over 2-7 days
● Reduced visual acuity
→ (+) visual field defect
→ 1/3 better than 20/40
→ 1/3 worse than 20/200
● Reduced color vision
● Reduced papillary response to light shone (+ RAPD)
● No associated systemic illness
● Periocular pain in 90% exacerbated by eye movement in 50%
● Retina: edematous around the nerve head and vessels become engorged
● Prominent manifestation: pain on movement of the eye
OPH.2.10.CASE DISCUSSION 5

A-TG5
OPH.SBR1 Samplex Based Ratio – Quiz 1 4 of 4