Retina Crossword and OSCE : tnoa Journal of Ophthalmic Science and Research

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Retina Crossword and OSCE

Mohan, Sashwanthi; Mohankumar, Arthi1; Rajan, Mohan

Author Information
TNOA Journal of Ophthalmic Science and Research 61(1):p 145-146, Jan–Mar 2023. | DOI: 10.4103/tjosr.tjosr_115_22
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I. Retina Crossword:

Clues:

Across

3. Systemic association of RAM lesions

6. Type of detachment seen in uveitic eyes on OCT

7. Most common cause of posterior uveitis

9. Name for rearrangement of photoreceptors after retinal injury on OCT (three words)

Down

1. Diagnostic test for Best disease

2. What does Pagenax contain?

4. Inner-outer segment on OCT (two words)

5. Retinal tumour seen in tuberous sclerosis

8. Breaks in the Bruch's membrane (two words)

Answers:

II. Objective Structured Clinical Examination (OSCE)

A 25–year-old gentleman presented with complaints of decreased vision in both eyes (OU) for the past 8 years. Best corrected visual acuity was 6/36: N8 in right eye and 6/60, N8 in left eye. Anterior segment of OU was within normal limits. Fundus of OU is as shown:

Questions:

  1. What is the most probable diagnosis?
  2. What is the most common mutation?
  3. What are the typical macular findings?
  4. What are the pisciform flecks made of?
  5. What is the typical fundus fluorescein angiography (FFA) finding?

Answers:

  1. Stargardt disease/Fundus flavimaculatus/Juvenile macular dystrophy
  2. ABCA4 gene located on chromosome 1 inherited in an autosomal recessive manner
  3. The macula can be normal in the early stages of the disease. As the disease progresses pigment mottling in a typical 'beaten bronze metal' appearance, and bulls-eye maculopathy develops culminating in macular atrophy.
  4. Fundus flecks are described as dot-like or round yellowish-white lesions in the mid periphery in patients with Stargardt disease. Newer flecks represent lipofuscin accumulation, and older ones represent areas of RPE atrophy and depigmentation. This can be differentiated using short wave blue autofluorescence.
  5. FFA reveals a 'dark choroid' in more than 60% of the patients. It is the lack of normal choroidal flush, which is blocked by high-grade lipofuscin accumulation in retinal pigment epithelium. This also leads to improved visualization of the small retinal capillaries that become easily evident over the dark, non-fluorescent and high-contrast choroid.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

© 2023 TNOA Journal of Ophthalmic Science and Research | Published by Wolters Kluwer – Medknow