Unit 5 - RVOs COPY 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?

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

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
What % of patients improved 15 letters with anti-vegf?
50%
26
What are the problems with steroid IV?
Cataract High IOPs
27
Which area of the retina is the most likely to be effected by NVE?
The border between perfused and non-perfused retina.
28
What are the NICE approved treatments for BRVO?
Eylea first line Lucentis if grid laser ineffective Dexamethasone if grid laser ineffective/impossible
29
How quickly should an RVO be referred as recommended by College of Optometrists?
Urgent referral. MEH suggests CRVO seen in an MR clinic within a month and BRVO within 3 months
30
What 3 phases are there in BRVO?
**Acute** phase: diffuse leakage, ir haems **Intermediate** phase: collateral formation **Chronic** phase: venous sheathing
31
Which study showed that steroids were as effective as anti-VEGF?
SCORE
32
Which study showed that anti-VEGF was better that grid laser?
VIBRANT
33