RETINA - VASCULAR RETINOPATHIES Flashcards
what are the 3 types of plaques? What is the site of origin for each?
- Fischer plaque - carotid origin
- Hollenhorst (carotid) plaque - carotid origin
- Calcific plaque - aortic /mitral valve origin
which plque is the most common of the 3?
Hollenhorst plaque
Which one appears at vessel bifurcations as a yellow spot?
Hollenhorst plaque
Which plaque is the most dangerous of the 3? why?
Calcific plaque - not malleable, thus can lead to complete blockage.
which plaque appears close to the ONH?
Calcific plaque
Why does a hollenhorst plaque travel further than a calcific plaque?
- Hollenhorst plaque is small, mallable and can easily break and travel further.
- Calcific plaque are bigger and not malleable thus harder to break and which keeps it at a closer location.
what is a CRAO? what plaque is associated with CRAO?
- CRAO is occlusion of the central retinal artery.
- associated with hollenhorst or calcific plaques (most common).
what systemic Dz are associated with CRAO/BRAO (in order from greatest)?
HTN > DM > Cardiac Dz > Carotid Dz
what are some signs of CRAO?
- pale retina
- cherry red spot
- chronic - whitening is resolved.
- optic disc pallor
what are symptoms of CRAO?
- acute, painless unilateral vision loss
- amaurosis fugax
what is a BRAO? what plaque is associated with a BRAO? why?
- occlusion of a branch of the central retinal artery.
- hollenhorst plaque - b/c it is smaller thus travels further.
what are signs of BRAO?
- one quadrant will be pale.
- permanent VF defect
what other condition must be r/o in someone with CRAO/BRAO?
GCA
how to tx/manage CRAO/BRAO?
tx is aimed at reducing eye pressure:
* hypervetilation into paper bag
* digital massage
* systemic acetazolamide (diamox)
* topical hypotensive gtts (timolol) x15minutes
* paracentesis
monitor regularly - to check for neo - if neo then PRP or anti-VEGF injections.
urgent referral to PCP - have higher risk of heart attack and stroke.
what is CRVO? what causes a CRVO?
- occlusion of the central retinal vein of the retina.
- caused by a thrombus that forms w/in the Central Retinal Vein.
what is a BRVO? what causes a BRVO?
- Occlusion one of the branch retinal veins.
- caused by a thrombus that forms in one of the small retinal veins prior to drainage into the central retinal vein.
what systmic Dz are are associated with CRVO/BRVO?
HTN > DM > cardiovascular Dz > POAG.
younger pts - oral contraceptives.
what are the signs of CRVO/BRVO?
- blood & thunder - hemes (flame hemes) / exudates / cws.
- dilated tortuous veins
- optic disc or/and macular edema.
- chronic - collateral vessels.
- serious - neovascularization of iris –> 90 day glaucoma.
CRVO - signs in all quadrants.
BRVO - signs in one quadrant (mainly superior temporal).
what are symptoms of CRVO/BRVO?
- sudden, painless, unilateral vision loss.
- amaurosis fugax.
- pain, if neo.
tx for CRVO/BRVO?
- no tx indicated unless there is edema or neo –> if edema/neo - tx w/ PRP/anti-VEGF
- monitor monthly for the 1st 6 months to check for edema or 90-day glaucoma.
- urgent referral to PCP for full cardiac eval.
- d/c oral contraceptives
- take aspirin prophylactically.
what is the % of those that may develop CRVO/BRVO in the fellow eye?
7%
what is OIS?
hypoperfusion of the anterior and posterior segments of the eye due to carotid obstructive disease (internal carotid artery is 90% blocked due to plaque build-up).
what is epidemiology for OIS?
- M >F
- > 50 yrs
systemic associations of OIS (greatest >least)
HTN > DM > cardiac > GCA.
- suspect cardiac DZ - #1 cause of mortality.
what are signs of OIS?
- mid-peripheral retinal hemes.
- dilated, non-tortuous, retinal veins.
- NVD/NVE
- rubeosis iridis - leads to NVG.
- corneal edema
will have both posterior and anterior findings!!!
tx/managment for OIS?
ocular tx aimed at halting neo and reducing any increased IOP:
* neo –> PRP/anti-vegf.
urgent referral to PCP for tx of HTN or cardiac Dz - OIS has high morbidity.
What is venous stasis
- same thing as OIS but only posterior segment findings.
- hypoperfusion to only posterior seg w/out anterior seg findings - due to carotid obstruction via plaque build up.
what are symptoms of venous stasis
- no complaints
- amaurosis fugax
what signs of venous stasis
- mid-peripheral hemes in all quads.
- no ischemia
tx for venous stasis?
- referr to PCP for managment of underlying DZ (HTN or cardiac DZ)
- do carotid doppler
what is the definition of hypertension?
BP above 140/90
what is HTN retinopathy?
signs of retinopathy 2/2 HTN
symptoms of HTN retinopathy?
- asymptomatic
signs of HTN retinopathy?
- flame hemes, CWS, exudates (macular star), vascular changes (narrowing, nicking, copper/silver wring).
- malignant HTN retinopathy –> inlcudes ONH swelling
define malignant HTN
BP above 220/120
tx/managment of HTN retinopathy
- check BP
- refer to PCP for HTN managment
- Malignant HTN – emergent (same day) referral to hospital.
what population is HTN more prevalent?
black
what is retinal artery macroaneurysm (RAMA)?
- it is isolated dilated area of a major retinal arterial branch
epidemiology of RAMA?
elderly woman w/ HTN or atherosclerosis
**
what systemic Dz is RAMA associated with?
- HTN
- artherosclerosis
- cardiovascular Dz
s/s of RAMA?
**symptoms: **
* Asymptomatic, but can have:
* Gradual vision loss - from macular edema.
* Sudden vision loss - from vitreous hemorrhage.
**signs: **
* UNILATERAL
* Unilateral focal area of dilation (ballooning) in a retinal artery.
* if rupture –> pre-retinal or vitreal hemorrhage & exudates.
* Scleroses - Once bleeding occurs.
* Macular edema - possible.
tx/managment for RAMA?
- no tx b/c usually resolve.
- if leaking –> PRP
- sub-foveal and vitreal heme can be tx with vitrectomy.
- refer to PCP for HTN managment.
