Retina and Vitreous — 2026–2027

Front Matter

• Introduction to the BCSC — xvii
• Introduction to Section 12 — xix
• Objectives — 1

PART I: Fundamentals and Diagnostic Approaches — 3

Chapter 1: Basic Anatomy — 5

• Vitreous — 5
• Neurosensory Retina — 7
  • Retinal Topography — 7
  • Retinal Layers and Neurosensory Elements — 9
  • Retinal Vasculature and Oxygen Supply — 13
• Retinal Pigment Epithelium — 14
• Bruch Membrane — 16
• Choroid — 17
• Sclera — 17
• References — 18

Chapter 2: Diagnostic Approach to Retinal and Choroidal Disease — 19

• Introduction — 19
• Ophthalmoscopy — 19
  • Examination With the Binocular Indirect Ophthalmoscope — 20
  • Indirect Ophthalmoscopy With the Slit Lamp — 20
• Imaging Technologies — 21
  • Fundus Camera Imaging — 21
  • Scanning Laser Ophthalmoscopy — 21
  • Optical Coherence Tomography — 23
  • Optical Coherence Tomography Angiography — 25
  • Fundus Autofluorescence — 27
  • Adaptive Optics Imaging — 30
  • Retinal Angiographic Techniques — 30
  • Ultrasonography — 36
• References — 38

Chapter 3: Retinal Physiology and Psychophysics — 39

• Electrophysiologic Testing — 39
  • Electroretinography — 39
    • Full-Field Electroretinography — 39
    • Multifocal Electroretinography — 46
    • Pattern Electroretinography — 46
  • Electro-Oculography — 48
  • Visual Evoked Potential — 49
• Psychophysical Testing — 50
  • Microperimetry — 50
  • Color Vision — 51
  • Contrast Sensitivity — 53
  • Dark Adaptometry — 53
• References — 53

PART II: Diseases of the Retina and Vitreous — 55

Chapter 4: Age-Related Macular Degeneration — 57

• Age-Related Macular Degeneration Studies — 57
• Introduction — 59
• Genetics and AMD — 60
• Nonexudative AMD — 61
  • Drusen — 61
  • Abnormalities of the Retinal Pigment Epithelium — 64
  • Differential Diagnosis of Nonexudative AMD — 66
  • Management of Nonexudative AMD — 68
• Neovascular AMD — 71
  • Signs and Symptoms of Neovascular AMD — 71
  • Anatomical Classification of MNV — 71
  • Nonexudative Neovascular AMD — 72
  • Differential Diagnosis of Neovascular AMD — 80
  • Management of Neovascular AMD — 80
• References — 89

Chapter 5: Diabetic Retinopathy — 91

• Introduction — 91
• Diabetic Retinopathy and Diabetic Macular Edema Studies — 91
• Terminology and Classification — 92
  • Diabetes Terminology — 92
  • Diabetic Retinopathy Terminology — 92
• Epidemiology of Diabetic Retinopathy — 93
• Pathogenesis of Diabetic Retinopathy — 93
• Recommended Diabetes Mellitus–Related Ophthalmic Examinations — 95
• Systemic Medical Management of Diabetic Retinopathy — 96
• Nonproliferative Diabetic Retinopathy — 99
  • Treatment of Nonproliferative Diabetic Retinopathy — 101
• Proliferative Diabetic Retinopathy — 105
  • Management of Proliferative Diabetic Retinopathy and Its Complications — 106
  • Additional Vision-Threatening Complications of Diabetic Retinopathy — 111
• Diabetic Macular Edema — 112
  • Classification of Diabetic Macular Edema — 112
  • Management of Diabetic Macular Edema — 115
• Management of Diabetic Retinopathy and Diabetic Macula Edema in Pregnant and Postpartum Patients — 119
• Cataract Surgery in Patients With Diabetes Mellitus — 120
• References — 121

Chapter 6: Retinal Vascular Diseases Associated With Cardiovascular Disease — 123

• Systemic Arterial Hypertension and Associated Ocular Diseases — 123
  • Hypertensive Retinopathy — 123
  • Hypertensive Choroidopathy — 124
  • Hypertensive Optic Neuropathy — 125
• Retinal Venous Occlusion — 126
  • Overview of Retinal Venous Occlusion — 126
  • Branch Retinal Vein Occlusion — 136
  • Central Retinal Vein Occlusion — 139
• Ocular Ischemic Syndrome and Retinopathy of Carotid Occlusive Disease — 142
  • Symptoms and Signs of OIS — 142
  • Etiology and Course of OIS — 143
  • Treatment of OIS — 144
• Arterial Occlusive Disease — 144
  • Cotton-Wool Spots — 145
  • Branch Retinal Artery Occlusion — 146
  • Central Retinal Artery Occlusion — 148
  • Cilioretinal Artery Occlusion — 152
  • Ophthalmic Artery Occlusion — 153
  • Paracentral Acute Middle Maculopathy — 153
• Arterial Macroaneurysms — 154
• References — 156

Chapter 7: Other Retinal Vascular Diseases — 157

• Sickle Cell Disease and Retinopathy — 157
  • Sickle Cell Disease — 157
  • Stages of Sickle Cell Retinopathy — 158
  • Nonproliferative Sickle Cell Retinopathy — 159
  • Proliferative Sickle Cell Retinopathy — 159
  • Other Ocular Abnormalities in Sickle Cell Hemoglobinopathies — 161
  • Management of Sickle Cell Retinopathy and Its Complications — 164
• Vasculitis — 165
• Cystoid Macular Edema — 166
  • Etiologies of CME — 167
  • Treatment of CME — 167
• Coats Disease — 167
  • Coats-like Reaction in Other Retinal Conditions — 169
• Macular Telangiectasia — 169
  • Macular Telangiectasia Type 1 — 169
  • Macular Telangiectasia Type 2 — 169
  • Macular Telangiectasia Type 3 — 172
• Neurocutaneous Syndromes — 172
  • Retinocerebral Angiomatosis — 172
  • Racemose Hemangioma — 173
  • Retinal Cavernous Hemangioma — 174
• Radiation Retinopathy — 175
• Valsalva Retinopathy — 177
• Purtscher Retinopathy and Purtscher-like Retinopathy — 178
• Terson Syndrome — 179
• References — 181

Chapter 8: Retinopathy of Prematurity — 183

• Introduction — 183
• Epidemiology — 183
• Classification, Terminology, and Clinical Features — 184
• Pathophysiology of ROP — 189
• Natural Course — 191
• Screening Recommendations — 192
  • Screening Criteria — 192
  • Fundus Photographic Screening of ROP — 193
  • ROP Training Resources — 194
• Prevention and Risk Factors — 194
• Treatment of Acute ROP — 194
  • Laser and Cryoablation Surgery — 198
  • Anti-VEGF Drugs — 198
  • Vitrectomy and Scleral Buckling Surgery — 200
• Associated Conditions and Late Sequelae of ROP — 201
• Medicolegal Aspects of ROP — 203
• Familial Exudative Vitreoretinopathy — 205
• References — 207

Chapter 9: Choroidal Disease — 209

• Central Serous Chorioretinopathy — 209
  • Demographics and Features — 209
  • Systemic Associations — 211
  • Imaging — 211
  • Differential Diagnosis — 215
  • Treatment — 215
• Choroidal Perfusion Abnormalities — 216
  • Arteritic Disease — 216
  • Nonarteritic Disease — 216
  • Choriocapillaris Blood Flow Abnormalities — 219
  • Increased Venous Pressure — 220
• Choroidal Neovascularization — 222
  • Ocular Histoplasmosis Syndrome — 222
  • Angioid Streaks — 222
  • Pathologic Myopia — 224
  • Idiopathic CNV and Miscellaneous Causes of CNV — 224
• Choroidal Folds — 224
• Choroidal Hemangiomas — 227
• Uveal Effusion Syndrome — 228
• Bilateral Diffuse Uveal Melanocytic Proliferation — 229
• References — 230

Chapter 10: Myopia and Pathologic Myopia — 231

• Definition, Prevalence, and Epidemiology — 231
• Prevention of Pathologic Myopia — 232
• The Retina and Choroid — 232
  • The Retina — 232
  • Bruch Membrane — 233
  • Choroidal Neovascularization — 235
  • The Choroid — 236
• The Sclera — 238
• The Optic Nerve — 239
• References — 239

Chapter 11: Infectious and Inflammatory Diseases of the Vitreous, Retina, and Choroid — 241

• Introduction — 241
• General Approach to the Patient with Posterior Uveitis — 241
• Infectious Posterior Uveitis — 242
  • Toxoplasmic Chorioretinitis — 242
  • Viral Retinitis — 243
  • Endogenous Bacterial Endophthalmitis — 245
  • Fungal Endophthalmitis — 247
  • Ocular Tuberculosis — 250
  • Syphilitic Retinochoroiditis — 250
  • Ocular Bartonellosis — 251
  • Toxocariasis — 252
  • Ocular Lyme Borreliosis — 253
  • Diffuse Unilateral Subacute Neuroretinitis — 253
  • West Nile Virus Chorioretinitis — 255
• Noninfectious Posterior Uveitis — 255
  • White Dot Syndromes — 255
  • Noninfectious Posterior Uveitis in Systemic Autoimmune Disease — 265
• Uveitis Masquerades — 270
• References — 273

Chapter 12: Inherited Retinal and Choroidal Disease — 275

• General Overview — 275
  • Classification and Terminology — 275
  • Clinical Evaluation — 276
  • Genetic Evaluation — 276
  • Management Principles — 277
• Stationary Photoreceptor Diseases — 277
  • Cone Dysfunction Syndromes — 277
  • Congenital Stationary Night Blindness — 279
• Progressive Panretinal Photoreceptor Degenerations — 282
  • Rod–Cone Dystrophy — 282
  • Cone and Cone–Rod Dystrophies — 286
  • Leber Congenital Amaurosis — 287
  • Enhanced S-Cone Syndrome — 288
• Progressive Chorioretinal Degenerations — 289
  • Choroideremia — 289
  • Gyrate Atrophy — 290
  • Bietti Crystalline Dystrophy — 291
• Macular Dystrophies — 291
  • Stargardt Disease — 291
  • Best Disease — 294
  • Pattern Dystrophies — 295
  • Early-Onset Drusen With a Hereditary Basis — 296
  • Other Macular Dystrophies — 297
• X-Linked Retinoschisis — 298
• References — 301

Chapter 13: Retinal Degenerations Associated With Systemic Inherited Disease — 303

• Introduction — 303
• Ciliopathies — 303
• Syndromes With Infantile to Early Childhood–Onset Retinal Disease — 304
  • Usher Syndrome — 304
  • Bardet-Biedl Syndrome — 305
  • Other Ciliopathies With Retinal Involvement — 306
• Metabolic Diseases — 306
  • Neuronal Ceroid Lipofuscinoses — 307
  • Pigmentary Retinopathies With Dietary Interventions — 309
• Mitochondrial Disorders — 309
• Other Systemic Mendelian Conditions With Retinal Involvement — 310
  • Spinocerebellar Ataxia — 310
  • Alagille Syndrome — 311
  • Myotonic Dystrophy — 311
  • Incontinentia Pigmenti — 312
  • Dental Disease — 312
  • Albinism — 312
• References — 313

Chapter 14: Systemic Drug–Induced Retinal Toxicity — 315

• Overview — 315
• Drugs That Cause Abnormalities of the Retinal Pigment Epithelium/Photoreceptor Complex — 315
  • Chloroquine Derivatives — 315
  • Phenothiazines — 320
  • Miscellaneous Medications — 321
• Drugs That Cause Choroidal Changes and Serous Retinal Detachment — 321
• Drugs That Cause Macular Edema — 324
• Drugs That Cause Occlusive Retinopathy or Microvasculopathy — 325
• Drugs That Cause Crystalline Retinopathy — 325
• Drugs That Cause Color Vision or ERG Abnormalities — 326
• Drugs That Cause Other Ocular Toxicities — 329
• References — 329

Chapter 15: Diseases of the Vitreous and Vitreoretinal Interface — 331

• Posterior Vitreous Detachment — 331
• Epiretinal Membranes — 333
• Vitreomacular Traction Diseases — 335
• Developmental Abnormalities — 339
  • Tunica Vasculosa Lentis — 339
  • Prepapillary Vascular Loops — 339
  • Persistent Fetal Vasculature — 340
  • Hereditary Hyaloideoretinopathies With Optically Empty Vitreous: Wagner and Stickler Syndromes — 341
• Vitreous Opacities — 342
  • Opacities Associated With Vitreous Degeneration and Detachment — 342
  • Asteroid Hyalosis — 343
  • Vitreous Hemorrhage — 344
  • Pigment Granules — 344
  • Cholesterolosis — 344
  • Amyloidosis — 344
• References — 346

Chapter 16: Retinal Detachment and Predisposing Lesions — 347

• Examination and Management of Posterior Vitreous Detachment — 347
• Lesions That May Predispose Eyes to Retinal Detachment — 348
  • Lattice Degeneration — 348
  • Vitreoretinal Tufts — 349
  • Meridional Folds, Enclosed Ora Bays, and Peripheral Retinal Excavations — 350
• Lesions That Do Not Predispose Eyes to Retinal Detachment — 350
  • Cobblestone Degeneration — 350
  • Retinal Pigment Epithelial Hyperplasia — 351
  • Retinal Pigment Epithelial Hypertrophy — 351
  • Peripheral Cystoid Degeneration — 352
• Retinal Breaks — 352
  • Traumatic Breaks — 352
  • Trauma in Young Eyes — 354
• Prophylactic Treatment of Retinal Breaks — 355
  • Symptomatic Retinal Breaks — 356
  • Asymptomatic Retinal Breaks — 356
  • Lattice Degeneration — 357
  • Aphakia and Pseudophakia — 357
  • Fellow Eye in Patients With Retinal Detachment — 357
  • Subclinical Retinal Detachment — 357
• Retinal Detachment — 358
  • Rhegmatogenous Retinal Detachment — 358
  • Traction Retinal Detachment — 363
  • Exudative Retinal Detachment — 365
• Differential Diagnosis of Retinal Detachment — 366
  • Retinoschisis — 366
  • Differentiation of Retinoschisis From Rhegmatogenous Retinal Detachment — 367
• Macular Lesions Associated With Retinal Detachment — 368
  • Optic Pit Maculopathy — 368
  • Macular Holes in High Myopia — 370
• References — 370

Chapter 17: Posterior Segment Manifestations of Trauma — 371

• Classification of Ocular Globe Trauma — 371
• Evaluation of the Patient After Ocular Trauma — 372
• Blunt Trauma Without a Break in the Eye Wall — 373
  • Commotio Retinae — 374
  • Choroidal Rupture — 374
  • Posttraumatic Macular Hole — 375
  • Vitreous Hemorrhage — 377
  • Traumatic Chorioretinal Disruption — 377
• Open-Globe Injuries — 377
  • Scleral Rupture — 378
  • Lacerating and Penetrating Injuries — 379
  • Perforating Injuries — 379
  • Surgical Management — 379
  • Intraocular Foreign Bodies — 382
  • Posttraumatic Endophthalmitis — 385
• Prognostication of Globe Injuries — 386
• Sympathetic Ophthalmia — 386
• Avulsion of the Optic Nerve Head — 387
• Abusive Head Trauma — 387
• Photic Damage — 388
  • Solar Retinopathy — 389
  • Phototoxicity From Ophthalmic Instrumentation — 389
  • Occupational Light Toxicity — 391
  • Laser-Pointer Injury — 391
• References — 391

PART III: Selected Therapeutic Topics — 393

Chapter 18: Laser Therapy and Cryotherapy for Posterior Segment Diseases — 395

• Basic Principles of Photocoagulation — 395
  • Clinical Therapeutic Objectives of Laser Photocoagulation — 395
  • Choice of Laser Wavelength — 396
  • Practical Aspects of Laser Photocoagulation — 397
  • Complications of Photocoagulation — 400
• Transpupillary Thermotherapy — 401
• Photodynamic Therapy — 402
  • Complications of Photodynamic Therapy — 402
• Cryotherapy — 403
  • Cryopexy Technique — 403
• References — 404

Chapter 19: Vitreoretinal Surgery and Intravitreal Injections — 405

• Pars Plana Vitrectomy — 405
  • Vitrectomy Fundamentals — 405
  • General Surgical Principles — 407
• Vitrectomy for Selected Macular Diseases — 408
  • Macular Epiretinal Membranes — 408
  • Vitreomacular Traction Diseases — 409
  • Submacular Hemorrhage — 411
• Vitrectomy for Vitreous Opacities — 413
• Vitrectomy for Complications of Diabetic Retinopathy — 413
  • Vitreous Hemorrhage — 414
  • Diabetic Traction Retinal Detachment — 414
• Vitrectomy for Posterior Segment Complications of Anterior Segment Surgery — 415
  • Postoperative Endophthalmitis — 415
  • Retained Lens Fragments After Phacoemulsification — 419
  • Posteriorly Dislocated Intraocular Lenses — 420
  • Cystoid Macular Edema — 421
  • Suprachoroidal Hemorrhage — 422
  • Needle Injury of the Globe — 423
• Rhegmatogenous Retinal Detachment Surgery — 424
  • Techniques for Surgical Repair of Retinal Detachments — 425
  • Outcomes After Retinal Reattachment Surgery — 429
• Complications of Pars Plana Vitrectomy — 430
• Intravitreal Injections — 431
• References — 433

Chapter 20: Gene Therapy — 435

• Introduction — 435
• Gene Therapy Mechanisms — 437
  • Delivery Methods — 437
  • Gene-Specific and Gene-Targeted Approaches — 437
  • Gene-Agnostic Approaches — 440
• Current Limitations — 440
• References — 440

Additional Materials and Resources

• Additional Materials and Resources — 441
• Requesting Continuing Medical Education Credit — 443
• Study Questions — 445
• Answers — 455
• Index — 463