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Ophthalmology 👁 > Retinal Artery Disease > Flashcards

Retinal Artery Disease Flashcards

1
Q

Where does the central retinal artery enters the optic nerve?

A

1cm behind the globe

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2
Q

Retinal capillaries supplies?

A

The inner two thirds of the retina. The outer third is supplied by choriocapillaris.

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3
Q

Risk factors for DR

A

Duration and control of diabetes, pregnancy, hypertension and presence of severe nephropathy.
Other risk factors: hyperlipidaemia, obesity, smoking, anaemia and cataract surgery

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4
Q

Where is the inner and outer plexus of the retinal capillaries locates?

A

Inner plexus is in ganglion cell layer and outer plexus in inner nuclear layer

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5
Q

What tends to be the earliest sign of DR?

A

Microaneurysm

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6
Q

Diagnostic criteria for very mild NPDR

A

Microaneurysm only

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7
Q

Diagnostic criteria for mild NPDR

A

Any or all of: microaneurysms, retinal haemorrhages, exudates, cotton wool spots up to level of moderate NPDR
No IRMA or venous beading

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8
Q

Diagnostic criteria of moderate NPDR

A

Severe retinal haemorrhage in 1-3 quadrants (~20 medium-large per quadrant) or mild IRMA
Venous beading in no more than one quadrant

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9
Q

Diagnostic criteria for severe NPDR

A

4-2-1 rule, one or more of:

  • severe retinal haemorrhage in all 4
  • venous beading in 2 or more
  • moderate IRMA in 1 or more
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10
Q

Diagnostic criteria of mild-moderate PDR

A

NVD or NVE but not meeting high-risk PDR definition

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11
Q

Diagnostic criteria of high-risk PDR

A

NVD greater than 1/3 disc area
Any NVD with vitreous haemorrhage
NVE greater than 1/2 disc area

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12
Q

Definition of advanced diabetic eye disease

A

Tractional retinal detachment, persistent significant vitreous haemorrhage, neovascular glaucoma

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13
Q

Most common cause of visual impairment in diabetic patients

A

Diabetic maculopathy including oedema, exudate or ischaemia

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14
Q

Three most common ophthalmic complication of diabetes

A

Retinopathy, iridopathy (minor iris transillumination defect) and unstable refraction

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15
Q

What’s the average diameter of optic disc

A

1.5mm

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16
Q

Definition of clinically significant DMO

A

Oedema/retinal thickening within 1/3 disc diameter
Exudate within 1/3 disc diameter and associated with oedema
Oedema one disc area or larger and within 1 disc diameter of the center of macula

17
Q

What are the three things FFA show?

A
  1. Neovascularization
    - new vessels shown in early frames
    - leakage from new vessels shown in later frames as expanding hyperfluorescence
  2. Ischaemia
    - capillary dropout
18
Q

What medication is used to slow progression of diabetic retinopathy?

A

Fenofibrate 200mg daily

19
Q

Indication for PPV in DR

A
  1. Severe persistent vitreous haemorrhage precluding adequate PRP
  2. Progressive tractional retinal detachment threatening or involving macula
  3. Combined tractional and rhegmatogenous RD
  4. Premacular retrohyaloid/preretinal haemorrhage
20
Q

Grades of hypertensive retinopathy

A

Grade 1 - mild generalized arteriolar attenuation
Grade 2 - focal arteriolar attenuation/AV nipping/copper wiring of arterioles
Grade 3 - grade 2 + any of: retinal haemorrhage, exudate (“macular star”) and cotton wool spots
Grade 4 - severe grade 3 plus optic disc swelling, this is a marker of malignant hypertension

21
Q

Uses of OCT

A
  1. Optic nerve
    - glaucoma
    - optic neuropathies
  2. Retina
    - macular hole
    - macular pucker/ERM
    - macular oedema/exudates, IRF/SRF
    - vitreomacular traction
    - retinal detachment
    - RPE detachment (in central serous retinopathy or AMD)
22
Q

Layer of retina (innermost to outermost)

A 
Inner limiting membrane
Nerve fiber layer
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
External limiting membrane
RPE
Bruch membrane
Choroid
23
Q

Blood retinal barrier (inner and outer)

A

Inner - tight junction between retinal capillary endothelial cells
Outer - tight junctions of RPE also called zonula occludentes

24
Q

RVO risk factors

A

Age
HTN, chol, diabetes
Glaucoma +/- ocular hypertension - more for CRVO
OCP
Smoking
Uncommon: dehydration, myeloproliferative disorders, thrombophilia (hyperhomocysteinaemia, antiphospholipid syndrome, factor V Leiden mutation), inflammatory condition with occlusive periphlebitis (Behcet, sarcoidosis, wegener’s/GPA), orbital disease and CKD

25
Q

Fundal exam findings in acute BRVO

A

Dilatation and tortuosity of affected venous segment
Flame or dot and blot intraretinal haemorrhage
Cotton wool spots

26
Q

Most commonly affected quadrant in BRVO

A

Superotemporal

27
Q

Chronic changes in BRVO

A

Venous sheathing and variable persistent or recurrent haemorrhage
Collateral vessels (more obvious on FFA)
Chronic macular oedema (main cause of persistent poor vision after BRVO)
Retinal neovascularisation - 8% of eyes by three years (higher risk if five disc areas of non perfusion on FFA i.e. 1/3 of eye), NVE>NVD

28
Q

Prevalence of cilioretinal artery and significance in retinal vascular disease

A

15-50% population

Preserves central macular vision in CRAO, but worse in CRVO.

29
Q

Impending CRVO -> non-ischaemic CRVO -> ischaemic CRVO, in terms of symptoms and exam findings

A

Impending- usually asymptomatic or mild/transient blurring worse on waking; mild venous dilatation and tortuosity, few haemorrhage, mild macular oedema

Non-ischaemic: sudden painless monocular decrease in vision (but usually no worse than 6/60!); absent or mild RAPD, tortuosity and dilatation of all branches of central retinal vein, mild-mod haemorrhage, cotton wool spots, mild optic disc and macular oedema

Ischaemic: sudden severe painless visual loss, but can be painful if a/w neovascular glaucoma; VA usually CF or worse, RAPD present, rubeosis iridis or angle neovascularisation (gonioscopy important), severe tortuosity and engorgement of all branches, extensive haemorrhage, disc swelling and hyperaemia

30
Q

Chronic findings of CRVO

A

Macular atrophy, chronic CMO, RPE hyperplasia, ERM
Retinal neovascularisation in 5% of eyes (less common than BRVO) - increased risk I’d more than 10 disc areas of capillary dropout on FFA
Optic disc collateral

31
Q

Symptoms and signs of hemiretinal vein occlusion

A

An entity between BRVO and CRVO but less comm
Symptom is classically altitudinal visual field defect
Findings are in between in terms of vision, fundus findings (involving superior or inferior retinal hemisphere) and NVI
NVD is more common in hemiretinal vein occlusion than in CRVO or BRVO

Ophthalmology 👁 (4 decks)

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