Rubeosis

Question 1

OIS

Answer 1

• unilateral midperipheral hemorrhages/dilated non tortuous retinal veins/NVI/NVA (67% at time of dx)
• secondary to atherosclerosis (>90%) but also consider GCA
• risk factors=HTN, dm, cardiac disease

Question 2

Symptoms of OIS

Answer 2

Gradual vision loss (90%),dull periorbital pain/HA (40%), am fugax (10%)

Question 3

Prognosis of OIS

Answer 3

40% die within 5 years

Question 4

TX for OIS

Answer 4

• PRP for NV
• glaucoma surgery for NVG
• MD for carotid Doppler, carotid endarterectomy if <100% occluded
• order STAT CBC, ESR/CRP if suspect GCA

Question 5

OIS in back of eye vs whole eye

Answer 5

If only in the back of the eye=venous stasis retinopathy

If front and back of eye=OIS

Question 6

PDR

Answer 6

Loss of pericytes and damage to capillary BMs=breakdown in the BRB, ischemia with NVI/A/E/D and heme/CWS/exudates/IRMA/venous beading

Question 7

Type 1 DM

Answer 7

Juvenile onset, AI condition that destroys pancreatic B cells

• no insulin production
• weak genetic component
• may develop ketoacidosis
• no ret at time of dx

Question 8

Type 2 Dm

Answer 8

Adult, abnormal B cell secretion of insulin-resistant receptor cells

• strong genetic component
• assocaited with obesity
• 20% have NPDR at time of Dx

Question 9

Categories of DR

Answer 9

NPDR
=no neo, mid/mod/severe
-4-2-1 rule for severe=52% risk of PDR in 1 year

PDR
- NVD/E/A/I

Question 10

Threats to vision in DR

Answer 10

Mac disease-ischemia or edema (FA)

Proliferative Disease-hemorrhage, NVG, TRD

Question 11

Treatment for DR: EDTRS

Answer 11

Focal/grid laser for CSME=retinal thickening w/i 500um of fovea, hard exudates within 500um of fovea, with adjacent retinal thickening, 1DD of retinal thickening w/i 1dd of fovea

Question 12

Treatment for DR: RESTORE/RIDE/RISE/VIVID/VISTA

Answer 12

AntiVEGF for DME involving center of fovea and BCVA 20/40 or worse

Question 13

treatment for DR: DRS

Answer 13

PRP for PDR with HRC

-NV >1/4 DD w/i 1dd of ON, any NVD or NVE assocaited with pre-ret/VH

Question 14

CRVO

Answer 14

• artery compresses vein=turbulent blood flow=thrombus=vegf release=NV + 4 quadrants, heme/CWS/collaterals
• risk factors: HTN, DM, cardio disease, OAG
• threats to vision: mac disease and proliferative disease (18% develop NVI, 60% of ischemic develop NVI/33% develop NVG)
• treatment: check BP in office, eval q1month x 6m with gonio, refer to MD for eval for HTN, DM, CHF

Question 15

CRAO

Answer 15

• calcific plaque on heart valves=embolus=occlusion=ischemia/edema/superficial retinal whitening/cherry red spot
• less VEGF due to infarcted retina=only 5% develop NVI/NVG
• risk factors=HTN, DM, carotid occlusion disease, cardiac valve disease
• consider GCA workup without visible embolus
• urgently refer to ER for MRI to eval for stroke (24% have concurrent stroke)
• refer to MD for carotid and heart eval
• permanent VF/VA loss

Question 16

Prognosis for OIS

Answer 16

90% of patients will have count finger or worse VA at 1 year