• def.- separation of retina from retinal pigmented epithelium
• causes
  • rhegmatogenous tear (most common)
  • traction (ex: DM)
  • exudative
• symptoms
  • flashing lights
  • floaters
  • curtain coming across visual field

• scleral buckling- placement of an encircling band around the eye
• vitrectomy- surgical removal of vitreous humor
• pneumatic retinopexy
  • injection of a gas bubble into vitreous cavity combined with cryotherapy or laser to retinal break

• long duration of DM
• poor metabolic control
• pregnancy
• HTN
• renal disease
• obesity
• hyperlipidemia
• smoking
• anemia

1. basement membrane in central retinal A. thickens
2. endothelial cells damaged due to loss of pericytes
3. this leads to retinal edema which will cause an area of ischemia
4. body attempts to compensate by making new bv's via stimulation by VEGF, but these bv's are weak and frail

• microaneurysms usually temporal to fovea
• intraretinal dot and blot hemorrhage
• hard exudates (lipid excudate) frequently arranged in clumbs or rings
• retinal edema seen as thickening on biomicroscopy

• macula appears relatively normal
• poor visual acuity
• capillary nonperfusion

• stimulator of angiogenesis
• potent inducer of vascular permeability
• vessel survival factor
• fenestration factor
• proinflammatory effects
• neuroprotective effects

• grid treatment (for diffuse retinal thickening located close to center of fovea or close to temporal margin of disk)
  • gentle burns
  • one burn width apart
• focal treatment- for microaneurysm in center of hard exudate rings farther from center of fovea
  • gentle whitening or darkening of microaneurysm

affect 5-10% of diabetics

• flat or elevated
• severity determined by comparing with area of disc

1. trigger degradation of basement membrane of endothelial cells
2. endothelial cells then
   1. change shape and invade surrounding stroma
   2. proliferative and form migrating column
   3. cease proliferating, change shape, and adhere to each other
   4. form new capillary tube
3. sprouting tubes fuse into loops, creating circulation

• severe persistant vitreous hemorrhage
• dense, persistent premacular hemorrhage
• progressive proliferation despite laser therapy
• retinal detachment involving macula

• initial treatment is 2000-3000 burns
• spot size depends on contact lens magnification
• gentle intensity burn
• area covered by retinopathy
• follow up in 4-8 wks

• arterial
  • central (CRAO)- cherry red spot
  • branch (BRAO)- scotoma (spot in my vision I cant see)
• venous
  • central (CRVO)- four quadrants of heme
  • branch (BRVO)= A-V crossing changes

• dry (non-exudative)
  • drusen
  • geographic atrophy
• wet (exudative)
  • choroidal neovascularization (neovascular AMD)
  • serous PED (pigment epithelium detachment)

• poorly understood
• flawed transport between choroidal vessels and photoR's may be involved
• angiogenesis is feature of neovascular AMD
• genetic factors
• AMD potentially associated with a systemic vascular disorder

• patient presentation
  • visual acuity tsts
  • metamorphopsia
  • scotoma
• fundus biomicroscopy
• fundus angiography

vision loss

distortion

• assess best visual acuity
• screening for metamorphopsia
• fundus biomicroscopic evaluation of macula and peripapillary regions
• amsler grid
  • test one eye at time
  • test weekly to daily
  • find metamorphopsia or scotomas