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UCL Medical Retina 2 > Unit 5 - RVOs > Flashcards

Unit 5 - RVOs Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the three main types of RVO and their subtypes?

A
  • BRVO ( major branch, minor branch, non-ischaemic, ischaemic)
  • CRVO (non-ischaemic or ischaemic)
  • HRO (non-ischaemic or ischaemic)
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2
Q

What is the most common form of RVO?

A

BRVO

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3
Q

What is the peak age of incidence?

A

65-74

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4
Q

What systemic investigations should be conducted?

A
  • ESR
  • Full blood count
  • Blood pressure
  • Serum glucose
  • Fasting lipid test
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5
Q

What ocular investigations should be conducted?

A
  1. FFA
  2. OCT
  3. Undilated gonio to check for neovasc
  4. IOP
  5. RAPD
  6. VA
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6
Q

What is the differential diagnosis in RVO?

A

Diabetic retinopathy but would be bilateral and chronic rather than acute.

Ocular ischaemic syndrome

Other causes of optic disc swelling e.g. pap Radiation retinopathy

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7
Q

What is Virchow’s triad?

A

Any lumen can be obstructed by hypercoagulability, haemodynamic changes and endothelial injury.

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8
Q

What are the acute causes of vision loss in CRVO?

A
  1. Haem at macula
  2. Macula oedema
  3. Ischaemia of the macula
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9
Q

What are the chronic causes of vision loss in CRVO?

A

Rubeotic glaucoma

Neovascularisation - vitreous haem

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10
Q

What ophthalmic risk factors are there in CRVO?

A
  1. Glaucoma
  2. Retrobulbar external compression e.g. thyroid eye disease, orbital tumour etc.
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11
Q

What % of CRVO are non-ischaemic?

A

80%

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12
Q

What % of non-ischaemic convert to ischaemic in the first year?

A

13% (unlucky 13!)

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13
Q

How many disc diameters of non-perfusion is the cut off from ischaemic to non-ischaemic?

A

10

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14
Q

What v/a would you expect in ischaemic vs non-ischaemic?

A

<6/60 and >6/36

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15
Q

Would you expect an RAPD in non-ischaemic CRVO?

A

Non, but likely in ischaemic

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16
Q

Would you expect cotton wool spots in non-ischaemic?

A

Yes, but less than in ischaemic

17
Q

How quickly will vision deteriorate in non-ischaemic?

A

subtle, intermittent visual loss, ischaemic will be an acute visual loss.

18
Q

What follow up should be considered for an ischaemic CRVO?

A
  1. Monthly follow up for 6/12
  2. Monthly gonio to look for NVA
  3. PRP when any NVA/NVI
  4. Consider prophylactic PRP
19
Q

What % of ischaemic CRVO patients will develop NVG?

A

1/3

20
Q

What are optic disc collaterals and what do they do to neovasc risk?

A

Enlarged connections between retinal vasculature and choroid. They take about 6 months to develop and reduce neovasc risk by 25X

21
Q

What are the two main ways of treating CMO?

A

Grid laser
Intravitreal injections (steroids or anti-VEGF)

22
Q

Why is grid laser not used much?

A

It resolves oedema but doesn’t improve v/a

23
Q

What two types of intravitreals can be used in CMO

A

Steroids

Anti-VEGF

24
Q

Why are anti-VEGF injections effective in CMO

A

VEGF is highest in CRO, 80 times higher than in wet AMD.

25
Q

What % of patients improved 15 letters with anti-vegf?

A

50%

26
Q

What are the problems with steroid IV?

A

Cataract

High IOPs

27
Q

Which area of the retina is the most likely to be effected by NVE?

A

The border between perfused and non-perfused retina.

28
Q

What are the NICE approved treatments for BRVO?

A

Eylea first line

Lucentis if grid laser ineffective

Dexamethasone if grid laser ineffective/impossible

29
Q

How quickly should an RVO be referred as recommended by College of Optometrists?

A

Urgent referral.

MEH suggests CRVO seen in an MR clinic within a month and BRVO within 3 months

30
Q

What 3 phases are there in BRVO?

A

Acute phase: diffuse leakage, ir haems

Intermediate phase: collateral formation

Chronic phase: venous sheathing

31
Q

Which study showed that steroids were as effective as anti-VEGF?

A

SCORE

32
Q

Which study showed that anti-VEGF was better that grid laser?

A

VIBRANT

33
Q

How can you differentiate collaterals from neovascularisation?

A

They originate from capillaries
They do not leak FA

34
Q

Which studies showed that anti-VEGF was safe in RVO?

A

Lucentis - Cruise and Horizon
Eylea - Galileo and copernicus

UCL Medical Retina 2 (30 decks)

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