clinical Flashcards
The fundoycopic findings of hemorrhage, AV nicking, cotton-wool spots, and dilated tortuous veins, along with retinal edema, in one quadrant of the eye, is most characteristic of what pathology?
a central venous occlusion
b branched venous occlusion
c central arterial occlusion
d central venous occlusion
branched venous occlusion
how can you remember the risk factors related to BRVO?
The dilated tortuous veins and can clott are the result of compression of the overlying artery which is atherosclerosed. Anything than can clog an artery is suspect
CV disease, HTN, diabetes, smoking, obesity, hyper coagulable state, and glaucoma
What are some reasons that neovascularization is bad?
Often these vessels are abnormal, friable, or prone to hemorrhage, this can increase pressure in the eye leading to glaucoma. Hemorrhage can block visual fields or acuity.
How can you treat macular edema or neovascularization that results from BRVO? What else can you treat BRVO with?
photocoagulation prevent vessel growth and leakage
Intravitrial injections
How do you get a blood and thunder funds?
CRVO (central)
CRVO can be broken down into ischemic and non-ischemic the latter having a less favorable prognosis. How can ischemic compensation by the eye lead to further problems months later?
neovascularization of the iris can cause a 3 month glaucoma. Red painful eye (IOP increase)
ischemic type also has more extensive hemorrhage and cotton wool spots
CRVO has what visual prognosis
poor
Not only can CRVO cause glaucoma, glaucoma is a risk factor for it along with what else?
over 50 HTN DM
Your patient presents with visual disturbance following a visit to the ophthalmologist who gave them an injection of a drug to help improve the patients macular edema secondary to a larger issue. You find it was kenalog and now the patients eye is looking cloudy. What was their likely diagnosis and complication?
CRVO
cataract
You see a patient that was diagnosed with CRVO 3 months ago. You remember that this condition can cause a reactive glaucoma but see no signs or symptoms of neovascularization of the iris. You decide to send them to an optometrist for prophylactic pan retinal photocoagulation to prevent the glaucoma. Was this the right call?
No, PRP has no benefit prior to NVI, but should be done promptly after NVI is seen. NVI is secondary to retinal vein occlusion or diabetic retinopathy and can cause acute angle closure glaucoma “3 month glaucoma” delayed treated is for RVO only.
Photo coagulation can be done for either severe non proliferation Diabetic retinopathy or proliferative DR and will significantly reduce the risk of eye damage (this therapy is the purpose behind frequent diabetic screening of the eyes).
It looks like dots on the retina and works by stoping vessel growth and leaks.
whats the most important predictor of vision for someone with CRVO; be specific?
initial visual acuity
20/40 or better unchanged
20/400 or less remain worse
in-between 1/3 each outcome
Patient presents with partial visual field loss in one eye and you see pacification of the retina around a branch artery. You remember that their is no acute treatment and this condition is usually self resolving. After r/o other causes you decide its branch retinal artery occlusion. What follow up studies might you be interested in?
this can be caused by 3 types of emboli: platelet, calcification, and cholesterol.
Listen and feel carotid artery plaque, check heart for diseased valves, and check hyper coagulability
Dave is a 65 y/o retired businessman with a hx of DM, HTN, and 20 pack years of smoking. He’s having trouble seeing and on fundoycopic exam you see a cherry red spot with decreased surrounding retinal pigment; what’s the most likely diagnosis, and etiology?
CRAO- he has all the risk factors and signs
likely from ipsilateral carotid artery atherosclerosis
how do you treat CRAO
no good therapy but most aim to decrease IOP via massage paracentesis or dislodging the clot. If you delay more than 90min you can have permanent vision loss and NVI.
