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X. Post Seg 2 > Retinal Vascular Disease > Flashcards

Retinal Vascular Disease Flashcards

1
Q

Hypoperfusion Syndrome was formerly known as

A

Venous Stasis Retinopathy

Note: this is a misnomer because the defect is in arteries not veins

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2
Q

Hypoperfusion Syndrome is caused by

A

A blockage in the carotid or ophthalmic artery

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3
Q

Hypoperfusion Syndrome is an early and often asymptomatic stage of

A

Chronic Ocular Ischemia Syndrome

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4
Q

With Hypoperfusion Syndrome, a patient may complain of

A

Dull, chronic ache (on ipsilateral side of blockage) + possible transient vision loss (amaurosis fugax)

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5
Q

Why might a bruit and decreased pulse be experienced in Hypoperfusion Syndrome?

A

Bruit — whooshing sound at site of obstruction
Blockage —> turbulent blood flow —> bruit

Pulse will be decreased downstream from obstruction

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6
Q

Bruits can be identified when blockage is at ___%

A

30-85%

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7
Q

What is the correct orientation of a stethoscope to identify a bruit?

A

Using the BELL

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8
Q

For definitive diagnosis of Hypoperfusion Syndrome, what test is required?

A

Carotid imaging

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9
Q

What clinical findings would you expect to see during a fundus exam in a patient with Hypoperfusion Syndrome?

A
  1. Peripheral/mid-peripheral dot blot hemes
  2. Dilated veins

Defects spare the posterior pole

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10
Q

Ocular Ischemic Syndrome is often misdiagnosed as…

A

Vein occlusion or Diabetic Retinopathy

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11
Q

What is the visual impact of a patient with Ocular Ischemic Syndrome?

A

50% of OIS pts Count Fingers within 1 year

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12
Q

Ocular Ischemic Syndrome is typically ____ (unilateral/bilateral)

A

Unilateral

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13
Q

What clinical findings might you see in Ocular Ischemic Syndrome? (7)

A
  1. NVD/NVI/NVE
  2. Conj congestion
  3. Sluggish pupils
  4. Iritis
    5.Corneal edema
  5. Cotton wool spots
  6. Elevated inflamm markers (CRP, homocysteine)
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14
Q

What testing is used to diagnose Ocular Ischemic Syndrome?

A

Carotid Doppler Ultrasound

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15
Q

What is the treatment for Ocular Ischemic Syndrome?

A
  1. Systemic management
  2. Anti-VEGF
  3. Treat ocular findings (e.g. Mac edema, iritis, etc)
  4. Surgery (endarterectomy, carotid artery sheathing)
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16
Q

Describe the Carotid Doppler Ultrasound and how to read the results.

A
  • Non-invasive
  • B-mode and Doppler ultrasound used
  • Best detects occlusions in vessels
  • PSV (Peak Systolic Velocity) and EDV (End Diastolic Velocity) is used to determine blockage
    if PSV > 125, there is at least a 50% blockage
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17
Q

What would you expect to see on IVFA in a patient with. Ocular Ischemic Syndrome?

A

Delayed retinal AV time and possibly macular edema in late phase

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18
Q

In conjunction with the primary diagnostic test, what other tests are performed to diagnose Ocular Ischemic Syndrome?

A
  1. Magnetic Resonance Angiography (MRA)
  2. Computerized Tomographic Angiography (CTA)
  3. IVFA
  4. ESR, CRP, CBC, + Cardio Work-up

CT is more accessible, but MRA gives better view of tissue

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19
Q

What values are most important when reading a Carotid Doppler?

A

PSV (Peak Systolic Volume) and EDV (End Diastolic Velocity)

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20
Q

Carotid Doppler: PSV of above 125 indicates

A

At least 50% blockage

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21
Q

What is the most common inherited blood disorder in the USA?

A

Sickle Cell Retinopathy

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22
Q

What is a hemoglobinopathy?

A

A genetic disorder with structurally abnormal hemoglobin

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23
Q

T/F: Both sickle cell patients and sickle cell trait carriers exhibit resistance to malaria

A

TRUE

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24
Q

HbA

A

Normal

25
Q

HbS

A

Sickle cell allele

26
Q

HbC

A

Benign Hemoglobinopathy

27
Q

HbThal

A

Decreased Hb production

28
Q

Which sickle cell alleles exhibit the worst systemic complications?

A

SS

29
Q

What sickle cell alleles exhibit most severe ocular complication?

A

SC and SThal

30
Q

What are some factors that exacerbate sickling of cells?

A
  1. Acidosis
  2. Hyperosmolarity
  3. Cold weather
  4. Dehydration
31
Q

What are the lab tests that can detect Sickle Cell?

A
  1. Solubility Test (SickleDex)
  2. Sickle Prep Test (Metabisulfite Slide Test)
  3. Hemoglobin Electrophoresis the only one that can determine genotype
32
Q

5 Stages of Sickle Cell Retinopathy

A
  1. Peripheral Arterial Occlusion
  2. Peripheral AV Anastomoses
  3. Pre-retinal sea-fan neo
  4. Vitreous hemorrhage
  5. TRD
33
Q

Non-proliferative signs of SCR

A
  1. Comma sign (conj)
  2. Ant Seg ischemia
  3. Silvering of arterioles
  4. ERM
  5. Retinoschisis
  6. Salmon patch hemes
  7. Sunburst pigment
  8. Refractile bodies
  9. Angioid Streaks
  10. Artery occlusion
  11. Peripheral anastomoses
  12. Hyphema
34
Q

Why do sickle cell patients have elevated IOP?

A

HbS polymerization in aqueous humor —> sickling of RBC —> TM blockage —> elevated IOP

35
Q

How do you treat hyphema?

A
  1. Cyclo
  2. Steroids
  3. Keep head tilted up
36
Q

What IOP lowering drop should be avoided in sickle patients and why?

A

CAIs; promotes sickling

Osmotic agents (can be used sparingly); increases blood viscosity

37
Q

SCR: 24-24 Rule w/ Hyphema

A

If IOP ≥ 24 mmHg over any 24 hr period, surgical intervention w/ ant seg washout (Parasynthesis)

38
Q

What is the Tx for Stage 1 Proliferative SCR?

A

Educate and monitor

39
Q

What is the Tx for Stage 2 Proliferative SCR?

A

Educate and monitor

40
Q

What is the Tx for Stage 3 Proliferative SCR?

A

Peripheral scatter photocoagulation/cryotherapy around sea fan

41
Q

What is the Tx for Stage 4/5 Proliferative SCR?

A

Vitreoretinal surgery + Anti-VEGF

42
Q

What are some complications associated with Vitreoretinal Surgery in SCR pts?

A

Systemic: pulmonary, cerebral, and thromboembolic complications + Ocular: ant seg ischemia and hemorrhage w/ 2º GLC

43
Q

What is the benefit to PSP/Cryotherpathy in SCR pts?

A

regression of neo fronds and decrease risk of VH

44
Q

T/F: VH is immediate indication for Vitreoretinal Surgery

A

FALSE; most of time time, VH settles w/ gravity & reabsorbs*

unless it affects vision

45
Q

Compare size of cells exhibited in uveitis vs retinal vasculitis.

A

Cells larger in retinal vasculitis

46
Q

Phlebitis

A

Inflammation of retinal veins

47
Q

Arteritis

A

Inflammation of retinal arteries

48
Q

Causes of retinal vasculitis

A

Either caused by primary ocular disease or as a specific presentation of systemic vasculitis

49
Q

Eales Disease

A

Idiopathic peripheral retinal phlebitis

50
Q

Typical Eales Disease pt

A

Young, healthy male from India, Pakistan, Afghanistan

51
Q

Hallmark of Eales

A

Frequent, recurrent VH

inflammation —> occlusion —> non-perfusion —> Neo —> VH

52
Q

Treatment for Eales

A

PRP (+ maybe Anti-VEGF)

53
Q

Susan Syndrome Triad

A
  1. Multiple BRAO
  2. Hearing Loss
  3. Encephalopathy
54
Q

Snowball lesions in corpus callosum is indicative for which disorder?

A

Susan Syndrome (Encephalopathy)

leads to stroke

55
Q

Typical Susan Syndrome Pt

A

Woman 30’s

56
Q

TX for Susan Syndrome

A

Corticosteroids + Immunosuppressants

57
Q

IRVAN stands for

A

Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis

58
Q

Stages of IRVAN

A
  1. Vasculitis, MA, Neuroretinitis, Exudation
  2. Angiographic evidence of capillary non-perfusion
  3. Post Seg NVD/NVE and/or VH
  4. Ant Seg Neo
  5. Neo GLC
59
Q

What stage of IRVAN warrants treatment?

A

Stage 2 (Capillary non-perfusion)

TX: PRP

X. Post Seg 2 (5 decks)

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