Retinal vein occlusion

Question 1

Central retinal vein occlusion pathophysiology

Answer 1

Thrombus forms in the retinal veins and blocks the drainage of blood from the retina

Question 2

Role of the central retinal vein

Answer 2

Runs through the optic nerve and is responsible for draining blood from the retina

Question 3

Composition of the central retinal vein

Answer 3

4 branched veins that come together to form the central retinal vein

Question 4

Consequences of central retinal vein occlusion

Answer 4

Pooling of blood in the retina

Causes leakage of fluid and blood causing macular oedema and retinal haemorrhages.

This results in damage to the retina and loss of vision.

Release of VEGF, which stimulates neovascularisation

Question 5

Presentation of central retinal vein occlusion

Answer 5

Sudden painless loss of vision

Question 6

Risk factors for central retinal vein occlusion

Answer 6

• Hypertension
• High cholesterol
• Diabetes
• Smoking
• Glaucoma
• Systemic inflammatory conditions such as SLE

Question 7

Features of central retinal vein occlusion on fundoscopy

Answer 7

Flame and blot haemorrhages

Optic disc oedema

Macula oedema

Question 8

Investigations for central retinal vein occlusion

Answer 8

Full medical history

FBC - leukaemia

ESR/CRP - inflammatory disorders

Blood pressure - HTN

Serum glucose -diabetes

Question 9

Management of central retinal vein occlusion

Answer 9

Referred immediately to an ophthalmologist

Secondary care:
- Laser photocoagulation

• Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
• Anti-VEGF therapies

Question 10

Aims of secondary care management

Answer 10

Treat macular oedema

Prevent complications -neovascularisation of the retina and iris and glaucoma

Question 11

Anti-VEGF therapies

Answer 11

Ranibizumab

Aflibercept

Bevacizumab