Vascular Flashcards
Flame-shaped hemorrhages - where
track along the nerve fiber layer
dot/blot shaped hemorrhages - where
outer plexiform/inner nuclear layers
Central retinal artery - layers
intima (single layer of endothelium resting on a collagenous zone), internal elastic lamina, media (smooth muscle), adventitia (loose connective tissue)
Retinal arterioles - characteristic feature
internal elastic lamina is discontinuous
Exudates - where in the retina
outer plexiform layer
Microaneurysms - where in retina
in the inner capillary plexus (inner nuclear layer)
DME - which layers
between the outer plexiform and inner nuclear layers; later it may also involve the inner plexiform and nerve fibre layers
Cotton wool spots - where in the retina
within the nerve fibre layer. They are clinically evident only in the post-equatorial retina
BRVO - quadrant most commonly affected
superotemporal
Neovascularization following BRVO
8% of eyes by three years. NVE are more common than NVD
BRVO - FA
peripheral and macular ischaemia (capillary non-perfusion, staining of vessel walls, vessel ‘pruning’ – small branches failing to fill), haemorrhage and oedema with collateral vessels commonly forming in established cases. Venous filling is delayed
BRVO - treatment
• NVE or NVD - sector photocoagulation. • NVI - urgent sector PRP. •edema - antiVEGF/Intravitreal dexamethasone implant • If visual acuity remains 6/12 or worse after 3–6 months due to macular oedema that is associated with good central macular perfusion on FA, laser may be considered
Impending (partial) CRVO - FAF and FA
FAF may reveal a fern-like perivenular appearance, and FA generally demonstrates an impaired retinal circulation
Non-ischaemic CRVO - FAF
characteristic fern-like perivenular hypoautofluorescence due to masking of background signal by oedema
Non-ischaemic CRVO - FA
delayed arteriovenous transit time, masking by haemorrhage, usually good retinal capillary perfusion and some late leakage
Rubeosis iridis after ischaemic CRVO - %
50%
Retinal neovascularization after ischaemic CRVO - %
5% of eyes – much less commonly than with BRVO
ischaemic CRVO - FA
marked delay in arteriovenous transit time, masking by retinal haemorrhages, extensive areas of capillary non-perfusion and vessel wall staining and leakage
CME following CRVO - treatment
Treatment is generally indicated for VA worse than 6/9 and/or with significant central macular thickening (e.g. >250 μm) on OCT, but is unlikely to be of benefit if 6/120 or worse. ○ anti-VEGF ○ Intravitreal dexamethasone implant - (Ozurdex®) ○ Intravitreal triamcinolone ○ Laser photocoagulation. Although macular oedema is anatomically improved, laser is typically not beneficial for visual outcome, except in some younger patients
NVI or angle neovascularization following CRVO - treatment
PRP 1500–2000 burns of 0.5–0.1 s duration. ○ anti-VEGF adjunctively every 6 weeks until the eye stabilizes
Papillophlebitis
under the age of 50 years who may have a higher prevalence of hypertension and diabetes. Disc oedema is the dominant finding, and retinal haemorrhages and other signs such as cotton wool spots are predominantly peripapillary and confined to the posterior pole
Supply of outer retina
ciliary arteries via the choriocapillaris
Supply of inner retina
CRA
Hollenhorst cholesterol plaques
refractile yellow–white cholesterol
fibrin-platelet aggregates
greyish elongated
calcific particles
non-scintillating white
Susac syndrome
CRAO, sensorineural deafness and encephalopathy
BRAO - FA
delay in arterial filling and hypofluorescence of the involved segment due to blockage of background fluorescence by retinal swelling
How often embolus is visible in CRAO?
20%
Robeosis iridis - how often after CRAO and how fast?
1 in 5 eyes, typically earlier than in CRVO (4–5 weeks)
Cilioretinal artery is present how often?
15–50% of eyes
Anterior chamber paracentesis
27-gauge needle to withdraw 0.1–0.2 ml of aqueous
Ocular ischaemic syndrome
uni, Gradual loss, amaurosis fugax, Ocular and periocular pain, persistent after-images, Diffuse episcleral injection and corneal oedema, Aqueous flare with few cells, Iris atrophy, Rubeosis iridis 90%, IOP may remain low, cataract, Venous dilatation, arteriolar narrowing, haemorrhages and occasionally disc oedema, NVD, NVE
Ocular ischaemic syndrome - FA
Delayed choroidal filling and prolonged arteriovenous transit
Hypertensive retinopathy - stages
Grade1.mild generalized arteriolar narrowing. 2.Focal narrowing, AV nipping, copper wiring. 3.Hemor, exudates, cotton wool. 4.Malignant, optic disc swelling
Hypertensive choroidopathy
hypertensive crisis in young, Elschnig spots-focal choroidal infarcts, small black spots surrounded by yellow haloes, Siegrist streaks - flecks linearly along choroidal vessels
Most common sickle cell disease to cause retinopathy
SC
Should be avoided in sickling disorders
Carbonic anhydrase inhibitors
THALASSAEMIA RETINOPATHY
Cataract, a smooth featureless iris, vascular tortuosity, angioid streaks, optic neuropathy and pigmentary retinal mottling
Retinal Artery Macroaneurysm
older hypertensive women, hyperlipidemia, one eye, macular leakage, exudate, saccular arteriolar dilation at arteriovenous crossing on a temporal vascular arcade, hemor intra, sub, preretinal bleeding
Coats disease
idiopathic retinal telangiectasia, early childhood, intraretinal and subretinal exudation, exudative RD. Unilateral visual loss, strabismus or leukocoria
Coats disease - treatment
• Laser ablation of points of leakage • Anti-VEGF • Intravitreal triamcinolone • Cryotherapy • PPV
Eales disease
idiopathic occlusive peripheral periphlebitis (sheating, superficial retinal hemor, may cotton), mostly indian young males, stage: inflammatory, occlusive, retinal neovasc. prognosis ok. tubercular protein hypersensitivity, recurrent VH, mild AAU, bi asymetrical
Purtscher retinopathy
chest and head trauma, microvascular damage → occlusion and ischemia
Purtscher-like retinopathy
fat or amniotic fluid embolism, acute pancreatitis, pre-eclampsia, systemic vasculitis
Purtscher retinopathy - biochemical
elevated complement 5a
Valsalva retinopathy
rupture of perifoveal capillaries → premacular hemor, VH may also, YAG laser membranotomy
Lipemia retinalis
creamy-white discoloration or vessels, hyperTG, chylomycrons, in extreme salmon color, VA ok but not ERG
