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Medical Retina > VASCULAR OCCLUSIONS AND HYPERTENSIVE RETINOPATHY > Flashcards

VASCULAR OCCLUSIONS AND HYPERTENSIVE RETINOPATHY Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the inner retina supplied by

A

the retinal artery and veins

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2
Q

what is the outer retina supplied via

A

the choroidal vasculature

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3
Q

which circulation does the cilio retinal artery come from and how many % of people have one

A

choroidal circulation

10-20%

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4
Q

name 2 types of artery occlusions

A

Retinal artery occlusion

Cerebrovascular

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5
Q

list 4 types of retinal artery occlusions

A
  1. Central retinal artery occlusion
  2. Branch retinal artery occlusion
  3. Transient ischaemic event – Amaurosis Fugax
  4. Cilioretinal artery occlusion
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6
Q

what type of artery occlusion does this demonstrate and what type of field defect would this px have

A

CRAO

this px has a cilio retinal artery - the fovea will still remain perfused hence can still see centrally as coming from the choroidal circulation

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7
Q

what type of artery occlusion does this represent

A

superior hemi retinal artery occlusion

superior trunk is affected

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8
Q

which type of artery occlusion does this represent

A

superior branch temporal artery occlusion

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9
Q

what type of elderly px’s are affected with a cilio retinal artery occlusion and which type of young px’s

A

elderly with GCA

young - usually a flow problem as opposed to an occlusion

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10
Q

what does this photo signify

A

CRAO cherry red spot with retinal and macula thickening/oedema

the fovea is not thickened hence the difference in colour

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11
Q

list 5 risk factors of a CRAO

A

• Age
• Cardiovascular risk factors
• GCA
• IVDU - drug takers
• Cosmetic fillers

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12
Q

list 5 GCA symptoms

A

• Headache – temporal
• Temporal tenderness
• Jaw claudication / ‘angina’
• Weight loss / loss of appetite
• PMR - shoulder aches

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13
Q

where should a px presenting with a CRAO be referred to

A

Refer to stroke team
GP/A&E

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14
Q

what 5 actions should be carried out for a px with a CRAO acute <4 hrs

A

Thrombolysis
re-breathing bag
ocular massage
Diamox
paracentesis

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15
Q

what is the management of someone presenting with a CRAO >4 hrs

A

Manage risks – refer stroke team/TIA clinic

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16
Q

list 3 variants of a BRVO

A

• Hemi
• Quadrant – superior temporal, inferior temporal, inf nasal, sup nasal
• Macular branch

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17
Q

list the 5 effects of a vein occlusion

A

• Venous outflow is reduced
• Flow within the retinal vessels reduced
• Resistance to arterial flow into the occluded system – (see video)
• Results in overall poor circulation within the affected area
• Retinal cell injury - Ischaemia - VEGF - which causes oedema

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18
Q

what is this FA image showing

A

BRVO

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19
Q

what can a cilio retinal artery be secondary to

A

secondary to CRVO

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20
Q

what condition does this OCT image show

A

CRVO

OCT shows thickening and hyper reflectivity in that region

21
Q

in which type of patients will you see a Central Retinal Vein Occlusion (CRVO) with associated cilioretinal artery occlusion and what type of prognosis will you expect

what will you want investigated for as a possible underlying cause for this px

A

Usually in young patients with CRVO

Good outcome in young patients - vision eventually recovers ~ in 6 months

Blood investigations - thrombophilia screen, vasculitis screen e.g. for suspect behcets disease

22
Q

what does this FA show

A

Retinal Vein Occlusion – macular BRVO

can see vessels above the fovea are tortuous with aneurysm which leak

23
Q

list 4 risk factors of a vein occlusion

A

Hypertension
Hypercholesteraemia
Age
Thrombophilia/inflammatory (in younger patients)

24
Q

name 2 complications from a retinal vein occlusion

A

• Macular oedema
• Neovascularisation

25
Q

In history taking, what question will you ask an older px and what 5 things will you ask a younger px

A

Older px: Cardiovascular risk factors – BP, cholesterol, CVA, MI

Young patients
• DVT/PE
• Miscarriages
• contraceptive pills
• family history
• oral ulcers

26
Q

list 6 investigations you will want to carry out on a suspect Vein Occlusion

A

• VA
• RAPD
• IOP
• gonioscopy
• Inflammation
• central venous pressure

27
Q

which 2 types of imaging will help with assessing a vein occlusion and why

A

• OCT
DRIL (Disorganization of Retinal Inner Layers)
CMO

• Angiography (FFA)
Confirm diagnosis
Assess perfusion – ischaemic/non-ischaemic

28
Q

what is the 2 management options for ischaemic crvo

A
  • monthly anti VEGF injections for 6 months and observe
    or
  • if very ischaemic , prophylactic PRP can be considered
29
Q

what will significantly large areas of ischaemia / non-perfusion result in - when seen in a crvo

A

high risk of neovascular complications

> 10DA in the posterior pole

30
Q

what 3 signs will you usually but not necessarily see in your clinical examination of an ischaemic crvo

A

RAPD
VA <3/60
multiple deep blot haem throughout retina

31
Q

what anterior segment sign can you seen from an ischaemic crvo and what can this lead to

A

Iris - rubeosis

Angle – causes neovascular glaucoma

32
Q

when is anti VEGF tx given to a person with ischaemic crvo and what needs to be controlled first

A

Given in NVG but control IOP before injecting

33
Q

what is the longer lasting tx option for neovascularisation due to ischaemic crvo

A

panretinal photocoagulation

34
Q

what is a common complication of ischaemic crvo

A

macula oedema

35
Q

what are the 2 tx options to treat macula oedema for a crvo and possible tx for a brvo

A

intravitreal steroids
anti VEGF

possible macula laser for brvo

36
Q

name 2 types of intravitreal steroidal injections used to treat a crvo

A

Ozurdex
IVTA

37
Q

what is the outcome of taking Intravitreal anti-VEGF to manage macula oedema due to ischaemic crvo

A

50% - 15 letter improvement

38
Q

what is the outcome of someone taking Intravitreal dexamethasone to treat macular oedema due to ischaemic crvo and name 2 disadvantages

A

40% - 15 letter improvement

Risk cataract (30%) / IOP rise (12-15%)

39
Q

name 3 signs of mild Hypertensive Retinopathy

A

Focal arteriolar narrowing
AV nipping
Copper wiring

40
Q

name 2 signs additional of moderate Hypertensive Retinopathy

A

Haemorrhages and cotton wool spots

in addition to
Focal arteriolar narrowing
AV nipping
Copper wiring

41
Q

name the 3 main signs of MALIGNANT Hypertensive Retinopathy

A

Haemorrhages
CWS
&
disc swelling

42
Q

in which types of patients will you find Hypertensive choroidopathy

name 3 conditions they can be suffering from

A

Usually in young patients with acute hypertension

Eclampsia/pre-eclampsia
Renal hypertension
Phaechromocytoma

43
Q

what causes Ocular Ischaemic Syndrome and what vessel is this a disease of

A

Poor perfusion to eye

Carotid artery occlusive disease
• >90% closure
• Reduces perfusion by 50%

44
Q

name 6 ways ocular ischaemic syndrome can be presented/detected

A

Sudden vision loss (41-66%)
Gradual vision loss (28%)
Amaurosis fugax (15%)
ocular pain (13%)
Bright light amaurosis (20%)
Incidental finding

45
Q

list 7 anterior signs of ocular ischaemic syndrome

A

AC activity
Iris atrophy
NVI/NVA/NVG
Corneal oedema
Cataract
Dilated episcleral vessels
IOP: 4-60mmHg - either v low or v high

46
Q

list 6 posterior signs of ocular ischaemic syndrome

A

Mid-peripheral ret haem
Venous dilataion
Mas
Easily inducible arterial pulsation
Arteriolar narrowing
NVD

47
Q

what 4 signs does FA show in an eye with ocular ischaemic syndrome

A

Patchy choroidal filling
Increased AV transit time
Capillary non-perfusion
Late leakage from arterioles

48
Q

what signs does an ultra sound show in ocular ischaemic syndrome

A

Reversal of flow / retrograde flow

Medical Retina (17 decks)

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