Q. 1 – Which of the the following are true.

  1. The Bruch’s membrane is thicker than the retinal pigment epithelium
  2. The Bruchs membrane is considered and hypothesised to have a role in axial length increase
  3. The Bruchs membrane  is a stretched firm membrane that does not develop folds.
  4. The Bruchs membrane opening is  does not match  the  clinical margins of the optic disc in emmetropia. 

Q. 2 – Which of the  following  are true and  found  in association with a choroidal tear following blunt trauma

  1. The anterior segment will  always be normal
  2. There may be development of  CNV.
  3. There is no loss of vision following a choroidal tear
  4. Choroidal tears are always associated with a retinal  detachment. 

QuizWise responses

Answer 1: 2

Answer:  The Bruchs membrane is considered to have a role in axial length increase, it is hypothesised that axial elongation may be related to the production of BM in the retroequatorial region.  While this still not proven.   The Bruchs membrane is  very thin and ranges between 2-5 microns, though some studies have found a slightly higher value.  The Bruchs membrane can form folds,  and these may be seen in patients with  hypotonic maculopathy, when we call them choroidal folds, but they are  actually Bruchs membrane folds.  These may also be seen in other conditions  and even after trauma.   The Bruch’s membrane  does generally match the clinical margins of the optic  disc  in emmtropia.  It is specially in moderate and high myopia with increased axial length where due to the development of a Gamma zone there is a gap between the clinical optic disc margin and the Bruch’s membrane opening. 

Answer 2: 2

The correct answer is 2. There is a very high possibility development of a CNVM in association  with a choroidal tear.  Initially there may be bleeding and this may be followed later with the development of a CNV.  A choroidal tear  specially when it involves at the macular and specially the fovea is associated with a significant decrease in vision.   A choroidal tear  is not always associated with a retinal detachment, however in view of the severity of blunt  trauma, one must always examine the retinal periphery and  make sure there are not trauma induced retinal tears which can lead to detachment. One may always  examine the  anterior segment for a deepening associated with angle recession,  lens subluxation and development of a trauma induced cataract.  

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