Retina

Question 1

Treatment for CRVO?

Answer 1

Secondary prevention of CVS Risk Factors (i.e. control BP, diabetes, smoking cessation help, thrombophilia screen)

If macular oedema -> anti-VEGF injections, intravitreally (or steroid implant)

If neovascularisation -> PRP (laser). This doesn’t improve vision, but prevents deterioration. Most effective if done before the neovascularisation leaks and causes vision loss.

Question 2

Which ocular and systemic investigations would you do in CRVO?

Answer 2

Ocular includes OCT to check for sub retinal fluid (macular oedema), FFA to visualise blood vessels and blockage in more detail

Systemic - BP, cholesterol, HbA1c, APL antibodies, Factor V Leiden

Question 3

How can CRVO be classified?

Answer 3

ischaemic (significant reduced VA and RAPD) versus non-ischaemic (VA not as significantly reduced and no RAPD)

Question 4

Retinal signs of CRVO?

Answer 4

Flame haemorrhages, cotton wool spots, tortuous blood vessels

Question 5

Symptoms and Retinal signs of CRAO?

Answer 5

Sudden painless loss of vision

Pale retina with cherry red spot (representing perfusion of fovea by choroidal circulation)

Question 6

Which investigations performed for CRAO?

Answer 6

Bloods including ESR and clotting

Carotid Doppler

ECG +/- Echo (to check for AF, which may indicate embolic nature of CRAO)

Question 7

What are the possible aetiologies of CRAO?

Answer 7

Embolic - AF, atherosclerosis

Carotid Artery Disease

GCA

Question 8

Management of CRAO?

Answer 8

Treat as stroke - refer to medical team for stroke management

Investigations for aetiology

Very limited evidence for methods to increase arterial perfusion such as ocular massage and IOP lowering agents

Ophthalmic artery thombolysis not done in UK