Clinical Atlas of Peripheral Retinal Disorders

163 Pages·1988·29.736 MB·English

by  Keith M. Zinn M.D. (auth.)

Clinical
Atlas of
Peripheral
Retinal Disorders
Avul ion of the
Vitreous Ba e
Ciliary Process
Detached
Zonular
Ora Serrata
raction
Tuft
Cy tic
Traction
Detached Tuft
Pars
Plana
Thinned
Retina
with
Partial
Thickne
Holes
Reticular
Pars Cy toid
Plana Degeneration
Pearl
Typical
Cystoid
Degeneration
Oral
Pearls
Ciliary Process
Subretinal
Pigment
Oral
Pearl
Inner
Layer
Holes
Ciliary
Proce e
Composite Fundus Pathology
Clinical
Atlas of
Peripheral
Retinal Disorders
Keith M. Zinn
Clinical Professor
Department of Ophthalmology
Mount Sinai School of Medicine
New York, NY 10029
Attending Ophthalmic Surgeon
Manhattan Eye, Ear, and Throat Hospital
New York, NY 10021
Illustrated by
David A. Tilden
Springer-Verlag
Keith M. Zinn, M. D.
Clinical Professor
Department of Ophthalmology
Mount Sinai School of Medicine
New York, NY 10029, USA
Attending Ophthalmic Surgeon
Manhattan Eye, Ear, and Throat Hospital
New York, NY 10021, USA
Illustrator
David Anders Tilden
Active Member: Association of Medical Illustrators
Active Member: Guild of Natural Science Illustrators
44 Wirl Way
Duxbury, MA 02332, USA
Cover Illustration
Congenital Hereditary Retinoschisis
(Juvenile Retinoschisis [Fundus]) (Plate 28)
Library of Congress Cataloging-in-Publication Data
Zinn, Keith M., 1940-
Clinical atlas of peripheral retinal disorders.
Bibliography: p.
Includes index.
1. Retina-Diseases-Atlases. I. Title.
[DNLM: 1. Retinal Diseases-atlases. WW17Z78c]
RE551.Z56 1988 617.7'3 88-6536
ISBN-13: 978-1-4612-8319-5 e-ISBN-13: 978-1-4612-3720-4
001: 10.1007/978-1-4612-3720-4
Text © 1988 by Keith M. Zinn
Art © 1988 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1988
All rights reserved. This work may not be translated or copied in whole or in part without the
written permission of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010,
USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in con
nection with any form of information storage and retrieval, electronic adaptation, computer
software, or by similar or dissimilar methodology now known or hereafter developed is for
bidden.
The use of general description names, trade names, trademarks, etc. in this publication, even
if the former are not especially identified, is not to be taken as a sign that such names, as under
stood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by any
one.
While the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibility for any errors or omissions that may be made. The publisher makes no warranty,
express or implied, with respect to the material contained herein.
9 8 7 6 5 4 3 2 1
To the memory of my father Victor Zinno His love of life and know
ledge was an inspiration for all those who were fortunate to know
him.
Leon Hess, a wonderful friend, for his many years of brotherly
advice and encouragement.
Robert Heidell, Esquire, for his wise counsel.
Irving H. Leopold, M. D.: a great clinician, teacher, and chief.
Charles L. Schepens, M. D.: a superb ophthalmic surgeon and
innovator, without whom this book would not have been possible.
Contents
List of Plates XI
Preface XIX
Chapter 1
Anatomic Considerations 1
The Vitreous 2
Vitreous Attachments to Intraocular Structures 4
Anterior Vitreous Cortex 4
Vitreous Base 4
Posterior Vitreous Cortex 4
Vitreous Canals and Spaces 6
Anatomic Nomenclature of the Fundus 8
The Neurosensory Retina 10
The Choroid 10
Choroidal Pigmentary Pattern 10
Vortex Venous System 10
Choroidal Landmarks 12
Equator 13
Pars Plana 14
Pars Plicata 14
Ora Serrata 15
Variations of Fundus Appearance 16
Fundus Appearance as a Function of Aging 16
Pars Plana Cysts 18
Fundus Appearance as a Function of Body Pigmentation 18
Albino 18
Blond 18
Brunette 18
Asian 18
Negro 18
Fundus Appearance as a Function of Refractive Error 22
Chapter 2
Classification System of Peripheral Retinal Degenerations 25
Chapter 3
Developmental Variations of the Peripheral Fundus 27
Variations of Ora Serrata Bays and Teeth 28
Ora Bays 28
Giant Teeth 28
Bridging Teeth 28
Ring Teeth 28
Bifid Teeth 28
VIII Contents
Meridional Folds 28
Granular Tissue (Tufts) 30
Noncystic Retinal Tuft (Granular Tag) 30
Cystic Retinal Tuft (Granular Globule, Patch) 30
Zonular Traction Tufts 30
Ora Serrata Pearls 30
Chapter 4
Trophic Retinal Degenerations 33
Inner Neurosensory Layer 34
Vitreous Base Excavations 34
Retinal Holes 34
Middle Neurosensory Layer 36
Typical Cystoid Degeneration 36
Reticular Cystoid Degeneration 38
Acquired Typical Degenerative Retinoschisis 38
Reticular Degenerative Retinoschisis 39
Outer Neurosensory Layer - Retinal Pigment Epithelium 40
Paving-Stone (Cobblestone) Degeneration 40
Peripheral Tapetochoroidal (Honeycomb) Degeneration 40
Equatorial Drusen 41
Chapter 5
Tractional Retinal Degenerations 43
Anatomic Classification of Retinal Tears 44
Partial-Thickness Peripheral Retinal Tears 44
Intrabasal Partial-Thickness Tears 44
Juxtabasal Partial-Thickness Tears 44
Extrabasal Partial-Thickness Tears 44
Full-Thickness Peripheral Retinal Tears 44
Oral Full-Thickness Tears 46
Retinal Dialyses (Juvenile) 46
Avulsion of the Vitreous Base 46
Giant Retinal Tears 48
Intrabasal Full-Thickness Retinal Tears 48
Juxtabasal Full-Thickness Retinal Tears 48
Extrabasal Full-Thickness Retinal Tears 48
Chapter 6
Trophic and Tractional Retinal Degenerations 51
White-with-or -without-Pressure 52
White-without-Pressure 52
White-with-Pressure 52
Snail-Track Retinal Degeneration 54
Lattice Retinal Degeneration 56
Contents IX
Hereditary Vitreoretinal Degenerations 58
Wagner's Hereditary Vitreoretinal Degeneration 58
Stickler's Syndrome 59
Congenital Hereditary Retinoschisis (Juvenile Retinoschisis) 60
Goldmann-Favre Disease 62
Familial Exudative Vitreoretinopathy 64
Snowflake Vitreoretinal Degeneration 66
Systemic Conditions Associated with Vitreoretinal Degenerations 68
Marfan's Syndrome 68
Homocystinuria 70
Ehlers-Danlos Syndrome 71
Chapter 7
Degenerative Conditions of the Vitreous Body 73
Asteroid Hyalosis 74
Synchisis Scintillans (Cholesterolosis Oculi) 75
Amyloidosis of the Vitreous 76
Chapter 8
Proliferative Retinopathies 79
Diabetic Retinopathy 80
Background Diabetic Retinopathy 80
Preproliferative Diabetic Retinopathy 80
Proliferative Diabetic Retinopathy 80
Retinal Vein Occlusion 82
Sickle Cell Retinopathy 84
Retrolental Fibroplasia 86
Chapter 9
Inflammatory Disorders 89
Sarcoidosis 90
Harada's Syndrome (Vogt-Koyanagi-Harada's Syndrome) 91
Pars Planitis (Idiopathic Peripheral Uveoretinitis) 92
Choroidal Detachments (Ciliochoroidal Effusion) 93
Choroidal Effusion Syndrome 94
X Contents
Chapter 10
Pigmentary Tumors of the Peripheral Retina 95
Choroidal Nevi 96
Congenital Hypertrophy of the Retinal Pigment Epithelium 96
Congenital Grouped Pigmentation ("Bear Tracks") 98
Metastatic Tumors to the Choroid 99
Choroidal Melanomas 100
Chapter 11
Retinitis Pigmentosa 103
Chapter 12
Developmental Disorders: Colobomas of the Retina and Choroid 107
Chapter 13
Long-Standing Retinal Detachments 109
Intraocular Fibrosis 110
Demarcation Lines 113
Chapter 14
Fundus Color Code 115
Bibliographies and References 131
General Bibliography 133
Specific Bibliography 133
Index 149
List of Plates
Frontispiece: Composite Fundus Pathology
PLATE 1
Regional Anatomy of The Vitreous 3
PLATE 2
Vitreous Attachments to Intraocular Structures 5
Posterior Cortical Vitreous Attachments to the Optic Nerve Head and Retinal Tissues
Simple Posterior Cortical Vitreous Detachment - Full Fundus
Simple Posterior Cortical Vitreous Detachment - Posterior Pole
Simple Posterior Cortical Vitreous Detachment - Cross Section
PLATE 3
Anterior Cortical Vitreous Canals and Spaces 6
PLATE 4
Shafer's Sign 7
PLATE 5
Anatomic Nomenclature of the Fundus 9
Superior Half and Inferior Half of the Retina
Temporal and Nasal Quadrants of the Retina of the Left Eye
Clock Method of Fundus Subdivision
PLATE 6
The Fundus 11
Specific Anatomic Landmarks of the Normal Fundus
PLATE 7
Cross-Section of Globe: Side View of
Fundus with Line Demarcating the Equator 13
PLATE 8
Three-Dimensional Cutaway View of the
Ciliary Body and Ora Serrata Region 14