Unit 5 - RAO, emboli, macroanuerysms

Question 1

What are the three main types of emboli and what are the colours of them?

Answer 1

Cholesterol (yellow)

Calcific (white)

Platelet-fibrin plaques (dull grey)

Question 2

Which emboli appears golden orange if light digital pressure is applied to the eye?

Answer 2

Cholesterol

Question 3

Which particles appear larger than the vessels that they are in?

Answer 3

Cholesterol

Question 4

Which emboli cause symptoms?

Answer 4

Cacific; more likely to occlude a vessel (CRAO or BRAO)

Platelet-fibrin (amaurosis fugax)

Cholesterol are symptomless

Question 5

What are Hollenhurst plaques?

Answer 5

Cholesterol particles

Question 6

What are the symptoms of CRAO?

Answer 6

Sudden painless loss of vision

Question 7

What VA will a person with CRAO have?

Answer 7

6/60 - NPL

Question 8

What are the 8 causes of CRAO?

Answer 8

1) Inflammation of artery (GCA, etc)
2) Emboli arising from heart or carotid
3) Vasospasm
4) Ocular - raised IOP, disc druses
5) Coagulopathies - leaukaemia
6) Infective - toxos, Lyme, cat-scratch
7) Pregnancy
8) CV factors - diabetes, high BP,etc

Question 9

What are the 5 signs of CRAO?

Answer 9

Retinal oedema, opacification and whitening

Cherry red spot at macula

RAPD

Visual field loss dependent on site of occlusion

OCT shows increased retinal hyperreflectivity

Question 10

What is the 6 diff diagnosis of CRAO?

Answer 10

1. AION
2. Lipid-related diseases e.g. Tay-sach
3. Quinine toxicitiy
4. Ocular ischaemic syndrome
5. Macula hole with retinal oedema
6. Traumatic retinal oedema

Question 11

What systemic investigations should be performed on CRAO patients?

Answer 11

1. BP
2. Blood sugars
3. Carotid artery doppler
4. CV work up

Question 12

What treatment is available for CRAO?

Answer 12

Nothing…..

Question 13

What is a macroaneurysm?

Answer 13

Dilation of retinal arteriole

Question 14

What systemic associations are there with macroaneurysms?

Answer 14

1. Hypertension
2. Embolic disease
3. Hyperlipidaemia

Question 15

Are men or women most likely to get macroaneurysm?

Answer 15

Women 3:1

Question 16

What subtypes of macroaneurysm are there?

Answer 16

Thrombotic (90%)

Exudative (10%)

Question 17

What is the treatment of thrombotic Macroaneurysm?

Answer 17

Nothing- observe for 3 months.

If leakage and mac oedema then anti-VEGF

Question 18

What is the treatment of exudative macroaneurysmss?

Answer 18

Anti-VEGF

Focal laser if lesion is persistent of macular exudation progresses.

Question 19

What are the symptoms of MAs?

Answer 19

Sudden blurring of vision but only if macula involved.

Question 20

What are the general signs of MAs?

Answer 20

Hard exudates and retinal oedema

Haem is visible, large and in multiple layers

Question 21

What systemic and ocular investigations should be conducted in MAs?

Answer 21

Ocular:

• FFA
• OCT
• ICG

Systemic:

• BP
• Lipids
• Blood glucos

Question 22

What is the diff diagnosis of MAs?

Answer 22

• Neovasc AMD but there would be drusen and RPE changes
• DR
• Retinal telengiectasia
• Retinal capillary haemangioma

Question 23

What is the management of CRAO?

Answer 23

Immediate referral to A&E

Question 24

What are the signs of thrombotic MA’s?

Answer 24

Haem which typically fibrose spontaneously

Question 25

What are the signs of exudative MAs?

Answer 25

Slowly increasing hard exudates

Question 26

What treatments are available for MAs?

Answer 26

Laser hyaloidotomy
Vitrectomy
Anti-Vegf
Observation