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Posterior Segment

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Viva and OSCE Exams in Ophthalmology

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Abstract

This chapter provides cases of common retinal pathologies examined in an OSCE. The chapter begins with a proposed systematic method for examining patients with posterior segment pathologies, followed with details on cases of retinal dystrophies, retinal degenerations, retinal vasculopathies, posterior uveitis and retinal and choroidal tumours.

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  • Abraham P, Yue H, Wilson L. Randomised, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2. Am J Ophthalmol. 2010;150:315–24.

    Article  CAS  PubMed  Google Scholar 

  • Boyer DS, Heier MD, Brown DM, Clark WL, Vitti R, Berliner AJ, Groetzbach G, Zeitz O, Sandbrink R, Zhu X, Beckmann K, Haller JA. Vascular endothelial growth factor trap-eye for macular edema secondary to central retinal vein occlusion. Six-month results of the phase 3 COPERNICUS study. Ophthalmology. 2012;119:1024–32.

    Article  PubMed  Google Scholar 

  • Boyer DS, Yoon YH, Belfort R, Bandello F, Maturi RK, Augustin AJ, Li XY, Cui H, Hashad Y, Whitcup SM. Three-year, randomised, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121:1904–14.

    Article  PubMed  Google Scholar 

  • Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S. Ranibizumab versus verteportin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44.

    Article  CAS  PubMed  Google Scholar 

  • Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N, Rundle AC, Rubio RG, Murahashi WY. Ranibizumab for macular edema following central retinal vein occlusion. Six-month primary end point results of a phase III study. Ophthalmology. 2010;117:1124–33.

    Article  PubMed  Google Scholar 

  • Brown DM, Nguyen QD, Marcus DM, Boyer DS, Patal S, Feiner L, Schlottmann PG, Rundle AC, Zhang J, Rubio RG, Adamis AP, Ehrlich JS, Hopkins J. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013;120:2013–22.

    Article  PubMed  Google Scholar 

  • Brown DM, Schmidt-Erfurth I, Do DV, Holz FG, Boyer DS, Midena E, Heier JS, Terasaki H, Kaiser PK, Marcus DM, Nguyen QD, Jaffe GJ, Slakter JS, Simader C, Soo Y, Schmelter T, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Zeitz O, Metzig C, Korobelnik JF. Intravitreal aflibercept for diabetic macular edema: 100-week results from the VISTA and VIVID studies. Ophthalmology. 2015;122:2044–52.

    Article  PubMed  Google Scholar 

  • Callanan DG, Gupta S, Boyer DS, Ciulla TA, Singer MA, Kuppermann BD, Liu CC, Li XY, Hollander DA, Schiffman RM, Whitcup SM. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120:1843–51.

    Article  PubMed  Google Scholar 

  • Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, Murahashi WY, Rubio RG. Ranibizumab for macular edema following branch retinal vein occlusion. Six-month primary end point results of a phase III study. Ophthalmology. 2010;117:1102–12.

    Article  PubMed  Google Scholar 

  • Campochiaro PA, Clark WL, Boyer DS, Heier JS, Brown DM, Vitti R, Kazmi H, Berliner AJ, Erickson K, Chu KW, Soo Y, Cheng Y, Haller JA. Intravitral aflibercept for macular edema following branch retinal vein occlusion: the 24-week results of the VIBRANT study. Ophthalmology. 2015;122:538–44.

    Article  PubMed  Google Scholar 

  • Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, Reeves BC. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 2013;382:1258–67.

    Article  CAS  PubMed  Google Scholar 

  • Cunha-Vaz J, Ashton P, Iezzi R, Campochiaro P, Dugel PU, Holz FG, Weber M, Danis RP, Kuppermann BD, Bailey C, Billman K, Kapik B, Kane F, Green K. Sustained delivery fluocinolone acetonide vitreous implants. Long term benefits in patients with chronic diabetic macular oedema. Ophthalmology. 2014;121:1892–903.

    Article  PubMed  Google Scholar 

  • Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the diabetes control and complications trial. Ophthalmology. 1995;102:647–61.

    Article  Google Scholar 

  • Dugel PU, Koh A, Ogura Y, Jaffe GJ, Schmidt-Erfurth U, Brown DM, Gomes AV, Warburton J, Weichselberger A, Holz FG. HAWK and HARRIER: phase 3, multicenter, randomized, double-masked trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology. 2020;127:72–84.

    Article  PubMed  Google Scholar 

  • Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991a;98:766–85.

    Article  Google Scholar 

  • Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991b;98:823–33.

    Article  Google Scholar 

  • Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ, Puliafito CA, Davis JL, Flynn HW, Esquiabro M. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. 2007;143:566–83.

    Article  CAS  PubMed  Google Scholar 

  • Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J, Goodwin S, Aroney C, McAllister IL, Fraser-Bell S. A randomised clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. 2014;121:2473–81.

    Article  PubMed  Google Scholar 

  • Haller JA, Bandello F, Belfort R, Blumenkranz MS, Gillie M, Heier J, Loewenstein A, Yoon YH, Jacques ML, Jiao J, Li XY, Whitcup SM. Randomised, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117:1134–46.

    Article  PubMed  Google Scholar 

  • Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U. Intraviteal aflibercept (VEGF Trap-Eye) in wet age-related macular degeneration. Ophthalmology. 2012;119:2537–48.

    Article  PubMed  Google Scholar 

  • Holz FG, Roider J, Ogura Y, Korobelnik JF, Simader C, Groetzbach G, Vitti R, Berliner AJ, Hiemeyer F, Beckmann K, Zeitz O, Sandbrink R. VEGF trap-eye for macular oedema secondary to central retinal vein occlusion: 6-month results of the phase III GALILEO study. Br J Ophthalmol. 2013;97:278–84.

    Article  PubMed  Google Scholar 

  • Ikuno Y, Ohno-Matsui K, Wong TY, Korobelnik JF, Vitti R, Li T, Stemper B, Asmus F, Zeitz O, Ishibashi T. Intravitreal aflibercept injection in patients with myopic choroidal neovascularization: the MYRROR study. Ophthalmology. 2015;122:1220–7.

    Article  PubMed  Google Scholar 

  • Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW, Esquiabro M. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO study. Am J Ophthalmol. 2009;148:43–58.

    Article  CAS  PubMed  Google Scholar 

  • Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, Sutter F, Simader C, Burian G, Gerstner O, Weichselberger A. The RESTORE study. Ranibuzumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118:615–25.

    Article  PubMed  Google Scholar 

  • National Institute for Health and Care Excellence. Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion [TA229]. [Online]. London: NICE; 2011. https://www.nice.org.uk/guidance/ta229. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Ranibizumab for treating diabetic macular oedema [TA274]. [Online]. London: NICE; 2013a. https://www.nice.org.uk/guidance/ta274. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Ranibizumab for treating visual impairment caused by macular oedema secondary to retinal vein occlusion [TA283]. [Online]. London: NICE; 2013b. https://www.nice.org.uk/guidance/ta283. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema after an inadequate response to prior therapy [TA301]. [Online]. London: NICE; 2013c. https://www.nice.org.uk/guidance/ta301. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Ranibizumab for treating choroidal neovascularisation associated with pathological myopia [TA298]. [Online]. London: NICE; 2013d. https://www.nice.org.uk/guidance/ta298. Accessed 15 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion [TA305]. [Online]. London: NICE; 2014. https://www.nice.org.uk/guidance/ta305. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Aflibercept for treating diabetic macular oedema [TA346]. [Online]. London: NICE; 2015a. https://www.nice.org.uk/guidance/ta346. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Dexamethasone intravitreal implant for treating diabetic macular oedema [TA349]. [Online]. London: NICE; 2015b. https://www.nice.org.uk/guidance/ta349. Accessed 11 Dec 2019

    Google Scholar 

  • National Institute for Health and Care Excellence. Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion [TA409]. [Online]. London: NICE; 2016. https://www.nice.org.uk/guidance/ta409. Accessed 11 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Aflibercept for treating choroidal neovascularisation [TA486]. [Online]. London: NICE; 2017. https://www.nice.org.uk/guidance/ta486. Accessed 15 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Age-related macular degeneration [NG82]. [Online]. London: NICE; 2018. https://www.nice.org.uk/guidance/ng82. Accessed 13 Dec 2019.

    Google Scholar 

  • National Institute for Health and Care Excellence. Voretigene neparvovec for treating inherited retinal dystrophies caused by RPE65 gene mutations [HST11]. [Online]. London: NICE; 2019. https://www.nice.org.uk/guidance/hst11. Accessed 15 Dec 2019.

    Google Scholar 

  • Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, Gibson A, Sy J, Rundle AC, Hopkins J, Rubio RG, Ehrlich JS. Ranibizumab for diabetic macular edema. Results from 2 phase III randomised trials: RISE and RIDE. Ophthalmology. 2012;119:789–801.

    Article  PubMed  Google Scholar 

  • Regillo CD, Brown DM, Abraham P, Yue H, Ianchulev T, Schneider S, Shams N. Randomised, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 1. Am J Ophthalmol. 2008;145:239–48.

    Article  CAS  PubMed  Google Scholar 

  • Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.

    Article  CAS  PubMed  Google Scholar 

  • Shield CL, Furata M, Berman EL, Zahler JD, Hoberman DM, Dinh DH, Mashayekhi A, Shields JA. Choroidal nevus transformation into melanoma. Arch Ophthalmol. 2009;127:981–7.

    Article  Google Scholar 

  • The ACCORD Study Group and ACCORD Eye Study Group. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010;363:233–44.

    Article  CAS  Google Scholar 

  • The Age-Related Eye Disease Study 2 (AREDS2) Research Group. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression. AREDS2 report no. 3. JAMA Ophthalmol. 2014;132:142–9.

    Article  CAS  Google Scholar 

  • The Age-Related Eye Disease Study Research Group. A randomised, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. AREDS report no. 8. Arch Ophthalmol. 2001;119:1417–36.

    Article  Google Scholar 

  • The Age-Related Eye Disease Study Research Group. The age-related eye disease study severity scale for age-related macular degeneration: AREDS report no. 17. Arch Ophthalmol. 2005a;123:1484–98.

    Article  Google Scholar 

  • The Age-Related Eye Disease Study Research Group. A simplified severity scale for age-related macular degeneration: AREDS no. 18. Arch Ophthalmol. 2005b;123:1570–4.

    Article  Google Scholar 

  • The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol. 1984;98:271–82.

    Article  Google Scholar 

  • The Branch Vein Occlusion Study Group. Prevention of neovascularisation and vitreous hemorrhage in branch vein occlusion. Arch Ophthalmol. 1986;104:34–41.

    Article  Google Scholar 

  • The CATT Research Group. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364:1897–908.

    Article  PubMed Central  Google Scholar 

  • The Central Vein Occlusion Study Group. Natural history and clinical management of central retinal vein occlusion. Arch Ophthalmol. 1997;115:486–91.

    Article  Google Scholar 

  • The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of diabetic retinopathy study (DRS) findings, DRS report number 8. Ophthalmology. 1981;88:583–600.

    Article  Google Scholar 

  • The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomised trial — diabetic retinopathy vitrectomy study report 3. Ophthalmology. 1988;95:1307–20.

    Google Scholar 

  • The Royal College of Ophthalmologists. Diabetic Retinopathy Guidelines. [Online]. London: The Royal College of Ophthalmologists; 2012. https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2013-SCI-301-FINAL-DR-GUIDELINES-DEC-2012-updated-July-2013.pdf. Accessed 11 Dec 2019.

    Google Scholar 

  • The Royal College of Ophthalmologists. Retinal Vein Occlusion (RVO) Guidelines. [Online]. London: The Royal College of Ophthalmologists; 2015. https://www.rcophth.ac.uk/wp-content/uploads/2015/07/Retinal-Vein-Occlusion-RVO-Guidelines-July-2015.pdf. Accessed 11 Dec 2019.

    Google Scholar 

  • The Royal College of Ophthalmologists Clinical Guideline. Referral pathways for adult ocular tumours. [Online]. London: The Royal College of Ophthalmologists; 2019. https://www.rcophth.ac.uk/wp-content/uploads/2018/11/Referral-Pathways-for-Adult-Ocular-Tumours-March-2019.pdf. Accessed 13 Dec 2019.

    Google Scholar 

  • UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  • Vingerling JR, Dielemans I, Hofman A, Grobbee DE, Hijmering M, Kramer CF, de Jong PT. The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology. 1995;102:205–10.

    Article  CAS  PubMed  Google Scholar 

  • Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT, Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110:1677–82.

    Article  CAS  PubMed  Google Scholar 

  • Wolf S, Balciuniene VJ, Laganovska G, Menchini U, Ohno-Matsui K, Sharma T, Wong TY, Silva R, Pilz S, Gekkieva M. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014;121:682–92.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK

    Timothy H. M. Fung & Winfried M. K. Amoaku

  2. Royal Derby Hospital, Derby, UK

    Timothy H. M. Fung

  3. University of Nottingham, Nottingham, UK

    Winfried M. K. Amoaku

Authors
  1. Timothy H. M. Fung
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  2. Winfried M. K. Amoaku
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Correspondence to Timothy H. M. Fung .

Editor information

Editors and Affiliations

  1. Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK

    Timothy H. M. Fung

  2. Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK

    Winfried M. K. Amoaku

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Fung, T.H.M., Amoaku, W.M.K. (2020). Posterior Segment. In: Fung, T., Amoaku, W. (eds) Viva and OSCE Exams in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-43063-4_10

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  • DOI: https://doi.org/10.1007/978-3-030-43063-4_10

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