Retina 5 - Retinopathy

Question 1

Central retinal artery occlusion and it’s signs?

Answer 1

•Usually paired from carotid artery
•Sudden loss of VA
- VA < CF
• Cilio-retinal artery

Signs:
• Afferent pupil defect
•Retinal nerve cell oedema
- Cherry red spot on fovea for 48hrs
• Optic atrophy

Question 2

Central Retinal Artery Occlusion Management?

Answer 2

• A central retinal artery occlusion is a stroke!
• No ophthalmic management likely to improve vision as result
• Refer to stroke unit URGENTLY - as could cause paralysis or death.

Question 3

Central retinal vein occlusion

Answer 3

• Sudden loss of vision
- 6/12 - HM
• Haemorrhages - Main sign
• Swollen disc
• Cotton wool spots
• Macular oedema

Question 4

Central retinal vein occlusion (Ischaemia vs non-ischaemia) signs:

Answer 4

~Ischaemic~
• Afferent pupil defect
• Severe visual loss
- <6/60
• Lots of haemorrhages
• High risk of rubeotic glaucoma

~Non-ischaemic~
• No Afferent pupil defect
• Moderate visual loss
- 6/60 or better
• Fewer haemorrhages
• Low risk of rubeotic glaucoma

Question 5

Rubeosis

Answer 5

•Cause of Ischaemic CRVO not treated
•Blood vessels grow on iris
- Obstructs angle causing severe and intractable glaucoma

Question 6

Management of CRVO

Answer 6

•Check IOP
•If Ischaemic
- Urgent referral
- 30% risk of rubeotic glaucoma
• If non-ischaemic
- Refer urgently if VA reduced, and macula oedema
- If good VA, routine referral

Question 7

Management if Rubeosis

Answer 7

• Pan retinal laser
• Intravitreal anti VEGF injection
•Glaucoma present;
- Shunt surgery - if not severe
- Cyclodiode laser - may lead to worse VA

Question 8

Management of CRVO macular oedema

Answer 8

• Intravetreal anti-VEGF
•Steroid

Question 9

Branch vein occlusion, signs and symptoms?

Answer 9

• Most commonly superior-temporal vein
•Venous nipping from hypertension
•Sudden loss of vision
- Frequently asymptomatic
• Haemorrhages - Confined to affected vein
• Macular Oedema
- Exudates and cotton wool spots
• New vessels and vitreous haemorrhages

Question 10

Management of branch vein occlusion

Answer 10

• If VA reduced, urgent referral for treatment of macula oedema
- Same as CRVO (ANTI-VEGF INJECTIONS)
• If VA normal, routine referral for management of risk factors
- High BP, Diabetes etc

Question 11

Retinopathy of prematurity statistics :

Answer 11

• Most common cause of blindness children worldwide
•Increasingly common in low + middle income countries
•In UK affects only children
- <30/40 before gestation
-<1,500g in weight when born

Question 12

Retinopathy of prematurity cause:

Answer 12

• Retinal vascularisation complete at 36/40
•If born before then, peripheral retina is ischaemic
•Ischaemia leads to new vessels
- Haemorrhage and traction detachment

Question 13

Management of retinopathy of prematurity:

Answer 13

•Good neonatal care
- Prevent excessive oxygen
•Screening of all at risk premature babies
- BIO or Retcam
•Laser treatment for threshold retinopathy

Question 14

Sickle Cell Retinopathy character description:

Answer 14

•Sickle cell anaemia occurs in W africa
- Heterozygous protects against malaria, caused by abnormality of haemoglobin
• “Sickling” of red cells blocks capillaries (ridged, not normal flexible discs)
- Retina ischaemia and new blood vessels
• SS too anaemic to damage retina
• SC has most severe disease

Question 15

Features of sickle cell retinopathy and treatment?

Answer 15

• Usually no symptoms
• Peripheral “sea fans”
•Laser if current bleeds
- Otherwise observe

Question 16

Inherited retinal dystrophies Types and their sub types:

Answer 16

•Most common cause of blindness in people <65 in EU and N. America
•Peripheral
- Retinitis Pigmentosa
- Choroideraemia
- Gyrate atrophy
•Central
- Stargardt’s
- Best’s
- Pattern dystophies

Question 17

What is Retinitis Pigmentosa and its signs/symptoms?

Answer 17

•Group of disorders characterised by loss of photoreceptors, can be many conditions
•Many different genetic disorders
•Features
- Night blindness
-Loss of peripheral vision
- Pigment in peripheral retina
- Reduced ERG

Question 18

Stargardt’s disease

Answer 18

•Cause by mutation in ABCA4 gene
- Interferes with metabolism of Vit A products from photoreceptors by preventing removal
•Loss of central vision
- Usually 2nd-3rd decade of life
•Flecked retina : Pale spots
• Loss of RPE at macula

Question 19

Best’s disease?

Answer 19

•Initial “egg yolk appearance”
•Later pigmentation at macula
•Reduced vision in 5th-6th decade of life
•Reduced Electro oculogram

Question 20

Inherited diseases management

Answer 20

•No treatment available at present
• Ensure partial sight/blind registration
• Low vision aids and mobility training
• Genetic counselling may be appropriate
•Advice about the type!