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Posterior Segment > Retinal Blood Vessel Anomalies > Flashcards

Retinal Blood Vessel Anomalies Flashcards

1
Q

What tests would you do for a minimal systemic workup?

A

-Blood pressure, pulse, respirations
-CBC with differential
-Auscultation of carotid artery

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2
Q

What could Low RBC Count signify? (diseases/conditions) (10)

A

Anemia
Bone marrow failure
Chronic kidney disease
hemolysis
bleeding
leukemia
malnutrition
vitamin deficiency
Pregnancy
Medication

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3
Q

What could High RBC count signify? (4 conditions)

A

Congenital heart disease
Dehydration
Renal cell carcinoma
Polycythemia vera

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4
Q

What can cause Low WBC count?

A

-Severe infections that use up white blood cells faster than they can be produced.
-Medications that destroy white blood cells (chemo or radiation)
-Autoimmune disorders that destroy white blood cells or bone marrow cells (lupus or RA)
-Viral infections that temporarily disrupt the work of bone marrow
-Congenital disorders that involve diminished bone marrow function
-Reaction to medication

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5
Q

What can cause High WBC count?

A

-An increased production of white blood cells to fight an infection (bacterial or viral)
-A disease of bone marrow, causing abnormally high production of white blood cells (leukemia)
-A reaction to a drug that increases white blood cell production
-An immune system disorder that increases white blood cell production (RA)
-Severe allergic reaction

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6
Q

What do you see with micro-aneurysms?

A

Blood
exudative change
edema

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7
Q

How big are micro-aneurysms? Are you able to see them with your 78D, 90D?

A

50-100 microns. No

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8
Q

In order to easily observe micr-aneurysms, what test/scan would you run?

A

1) IVFA- IV fluorescein angiography
2) Virtual angiography

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9
Q

What are micro-aneurysms a result of and associated with? Venous or artery-based disease? What capillary layer is this found in? What layer of the retina?

A

Result of hypoxia and associated with capillary destruction.
Associated with venous based disease
Deep capillary network
INL

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10
Q

If we know micro-aneurysms are in deep capillary network in the INL, what type of hemorrhages might we appear to see?

A

Dot-blot, intra-retinal hemorrhage

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11
Q

When you have a micro-aneurysm, what order do the signs appear in from the initial leakage of blood?

A

Leak from micro-aneurysm, edema, dot-blot hemorrhage, exudate

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12
Q

What is the comparison of appearance for micro-aneurysm on fluorescein angiography?

A

“Starry night”
looks like stars in space, little white spots

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13
Q

Where does the ballooning occur in micro-aneurysms?

A

In areas of hypoxia

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14
Q

Where do the “balloons” of micro-aneurysms point?

A

In the direction of ischemia

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15
Q

How does a micro-aneurysm start to leak? How does it stop?

A

The capillary endothelium begins to proliferate which weakens the capillary wall. The blood-retinal barrier then breaks which causes a leak.
It stops due to a spontaneous seal due to hyalinization

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16
Q

What are the two signs of active leakage from a micro-aneurysm?

A

Dot-blot hemorrhage and exudate

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17
Q

What do you always see with micro-aneurysms?

A

Edema

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17
Q

What is most common disease to cause micro-aneurysms?

A

Diabetes

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18
Q

What are the treatment options for micro-aneurysms that are vision-threatening and leaking in or very near the fovea/macula?

A

Intravitreal Injection (anti-VEGF)
Laser photocoagulation
Combo of the two

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19
Q

In early phase fluorescein angiography, how long does the fluorescein to go from the hand to the eye? What do you look for in early phase?

A

Takes 16 seconds from hand to the eye.
Looking for ischemia in the superficial capillary network, “dead spots of retina/ micro-ischemic events”

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20
Q

When looking for capillary drop-out/ischemia in fluorescein angiography, what capillary network is this typically associated with in the early phase?

A

Superficial capillary network
-Since the fluorescein is being pumped to retina, it is in the arteries which is located in the superficial capillary system.

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21
Q

In late phase fluorescein angiography, do you use OCTA or structural OCT to find leakage/ micro-aneurysms?

A

Structural OCT, appears as “starry night” white dot on gray backgrounds,.

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22
Q

What would an active leak of micro-aneurysm look like on Fluorescein angiography?

A

White dot with hyperfluoresce In the same area.

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23
Q

What does macro-aneurysm look like?

A

ballooning of major retinal blood vessel or arteriole

24
Q

How often are arteries involved with macro-aneurysms?

A

Most of the time. 2/3 of the time

25
Q

What are most macro aneurysms associated with? What percent?

A

75% are associated with high blood pressure

26
Q

Where are most macro aneurysms found? Are they unilateral or bilateral? Are you able to see them using your fundoscopy lenses? ?

A

Superior-temporal region
Unilateral
You can see them with fundoscopy lenses

27
Q

What are 3 possible outcomes that can be caused by macro aneurysms?

A

Chronic leakage- retinal edema
Rupture of aneurysm - acute hemorrhage (multiple layers of retina, vitreous)
Spontaneous Resolution- will scar over on its own

28
Q

What are the visual effects due to macro-aneurysms?

A

Depends on location, can have significant effect on vision if near macula

29
Q

What are treatment options for macro aneurysms that are vision threatening?

A

Laser photocoagulation
Anti-VEGF injection
Combo

30
Q

If macro aneurysms are not vision threatening or worsening, what is treatment?

A

Monitor and have them back in 3 months.

31
Q

If macro aneurysms are not vision threatening but is spreading and worsening, what is the treatment?

A

Laser photocoagulation
Anti-VEGF injection

32
Q

What are the most common types of Idiopathic juxtafoveal telangiectasia?

A

Group2 is most common
Group 1 is second most common

33
Q

What are telangiectasia?

A

widened blood vessels that look like a web

34
Q

How is idiopathic juntafoveal Telangiectasia Group 1: Aneursymal presented? How is their vision affected? is it unilateral or bilateral vision loss?

A

-Usually in younger males patients
-Have abnormal glucose tolerance (high blood sugar, pre-diabetic, not diagnosed with diabetes)
-Mild to moderate unilateral vision loss

35
Q

What kind of vision loss would you expect with diabetic retinopathy? (bilateral/unilateral)

A

Bilateral vision loss

36
Q

What are some ocular findings for Idiopathic Juxtafoveal Telangiectasia Group 1: Aneurysmal? (5)

A

1) Unilateral macular edema (ME) with macular cystic changes
2) Temporal foveal involved
3) Telangiectasia
4) Micro-aneurysms and venule changes(vein dives down)
5) Lipid deposition with chronic leakage

37
Q

What is the visual prognosis for Idiopathic Juxtafoveal Telangiectasia Group 1: Aneurysmal?

A

Mild to moderate vision loss
Not worse than 20/40 - 20/50

38
Q

Treatment options for Idiopathic Juxtafoveal Telangiectasia Group 1?

A

Photocoagulation
Anti-VEGF therapy - most patients want to prevent from progression

39
Q

Describe Idiopathic Juxtafoveal Telangiectasia Group 2: Parafoveal presentation

A

-Healthy middle aged males and females
-Abnormal glucose tolerance
-BILATERAL vision loss with macular atrophy
- More common, worse prognosis than IJT-1
-20/50 vision or worse

40
Q

Ocular findings for Idiopathic Juxtafoveal Telangiectasia Group 2: Parafoveal

A

-Grayish loss of juxtafoveal retinal transparency
Macula has opaque appearance to it; more obvious with red-free filter on BIO.
-Temporal early, but then surrounds entire fovea
-Fine crystalline deposits and RPE hyperplasia (black spots in left-most image)
-Micro-A and neovascularization with macula edema

41
Q

What technology would you use to diagnose Idiopathic Juxtafoveal Telangiectasia Group 1 and 2? (5)

A

1)Red-free (on SLE or BIO) or multi-color imaging (camera uses blue, green, & red lasers) – grayish macular reflex
2) Fundus Autofluorescence (FAF) – macular atrophy
3) OCT – neuro-retinal loss, structural changes
4)OCT-A – incompetent capillaries and micro-A
5)IVFA – temporal leakage

42
Q

What is the Idiopathic Juxtafoveal Telangiectasia - Therapy that is currently in phase 3 clinical trial? What are side effects?

A

ECT- encapsulated cell therapy
implant that gives continuous therapeutic NT-501 protein (neurotrophic factor) to the eye for 2 years.
SE: makes vision worse than it was intitial.

43
Q

Describe Idiopathic Juxtafoveal Telangiectasia Group 3: Occlusive

A

Rare condition
Associated with systemic diseases or neurological disease
Loss of central VA
optic atrophy
Related to capillary occlusion
microaneurysms

44
Q

Treatment for Describe Idiopathic Juxtafoveal Telangiectasia Group 3: Occlusive

A

None

45
Q

cystoid macular edema that develops 30-90 days post-cataract surgery

A

Irvine-Gass syndrome

46
Q

What are collateral blood vessels? How can they develop? Are they beneficial?

A

Blood vessels that develop within the framework of existing vessels.
Can develop vein-vein, artery-artery , or vein-artery.

47
Q

Name for collateral blood vessel that is located on the surface of the optic nerve

A

Optocilliary shunt

48
Q

Name for AV communication without capillary obstruction or compromise

A

Shunt vessel (congenital)

49
Q

What technology/imaging would you use for collateral blood vessels?

A

IVFA or OCT-A (indicated)
Possible MRI

50
Q

What could cause collateral blood vessels?

A

Orbital mass
RVO
Congenital

51
Q

Do Intra-retinal vascular abnormalities leak? (IRMA)

A

No

52
Q

True or false: IRMA (intra-retinal vascular abnormalities are a precursor to severe diabtetic retinopathy

A

True

53
Q

3 typical locations for neovascularization

A

1) Neovascularization of Iris (NVI)
2) Neovascularization of the disc (NVD)
3) Neovascularization elsewhere (NVE)

54
Q

Where does Neo develop?

A

Junction of healthy and hypoxic tissue

55
Q

Expected retinal findings for neovascularization?

A

Edema
Hemorrhage
Fibrosis and traction

56
Q

What kind of neovascularization is associated with the vitreous?

A

NVD

57
Q

What is the gold standard for observing neovascularization?

A

IVFA- IV fluorescein angiography

Posterior Segment (6 decks)

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