Vascular retinopathies Flashcards
Inner Blood Retinal Barrier is made up of _____, and its pathology is seen in _____ on FA.
Retinal capillaries tight-junctions, DM.
Outer Blood Retinal Barrier is made up of _____, and its pathology is seen in _____ on FA.
RPE Zonula occludens, AMD.
___% of DM patients have sight-threatening pathology, and ____% of all DM have some sort of pathology.
8%, 42&
___% of DM patients that lost sight in one eye will lose it in the other in a year, and ____% in 5 years
60%, 90%
Duration of DM increases the risk of DM retinopathy - ___% of DM patients under 10 years, and ____% in DM patients over 20 years
7%, 75%
PDR has vessels crossing the____.
ILM
Mild-Moderate NPDR findings:
MEH…
M - Micro-aneurysms.
E - Exudates (hard).
H - hemorrhage (dot, blot, flame).
Circinate is ____, and its clinical significance is ______.
a ring of hard exudates, significant central leak.
Severe NPDR findings:
BIC’S:
B - beading & looping of veins.
I - IRMA, intraretinal microangiopathy (new vessels don’t cross the ILM).
C - Cotton wool spots/ vessel closure.
S - Sclerosis of vessels.
Cotton wool spots are_____, and their significance is____.
focal ischemia and damage to NFL (axoplasmic flow damage), axons swelling.
Hard exudates are_____, and their clinical significance is____.
fat and protein precipitants, edema due to damage of the inner RBB.
On FA of NPDR patient, white spots are____.
Micro-aneurysms.
On FA of NPDR patient, black areas are____.
hemorrhage.
On FA of NPDR patient, it’s impossible to see____.
active bleeding.
NPDR patients are usually _____.
asymptomatic
NPDR patients will begin to experience symptoms with ______, and it is _____ to treat.
macular edema, possible.
Macular edema is _____ to treat.
possible
Ischemic maculopathy is _____ to treat.
not possible
NVD stand for______, and has ______ prognosis.
disc neo-vascularization, poor
NVE stand for______.
neo-vascularization elsewhere.
Immediate complication of PDR is ______.
tearing of pathologic vessels (due to movement of Vitreous body) -> bleeding-> “black screen”.
Later complication of PDR is ______.
Traction retinal detachment.
Traction retinal detachment in PDR’s pathophysiology:
Growth of pathologic vessels and fibrovascular membrane -> vessels gradually get absorbed -> fibrotic membrane remains that is attached to the retina in several locations ->Traction retinal detachment.
Rubeosis iridis is ______, and can lead to ______, and eventually _____.
Growth of pathologic vessels over the Iris, Vascular Glaucoma, impossible to rehabilitate.
Severe NPDR has the ____ rule.
4-2-1 rule - the patient is at increased risk for PDR:
4: 4 quadrants with aneurysms (4nurisms) or hemorrhages.
2: 2 quadrants with Venous beading (V sign for veins and 2 for 2 quadrants).
1: 1 quadrant of IRMA (1RMA)
Treatment of DM retinopathy?
Prevention: He PLANS to prevent!
He - HTN treatment
P - Pregnancy L - Lipideamia (HDL, LDL) A - Anemia N - Nephropathy and Proteinuria S - Suger (blood suger managment - most important!)
What is the DCCT, and its significance?
DM retinopathy study for DM1 patients. Found that strict adherence and treatment halted occurrence and progression of DM retinopathy by 5 times over.
What are the AR of the DCCT
Hypoglycemia and Fat gains
Unbalanced patients starting strict Blood sugar control will experience ___________.
progression of DM retinopathy for a year and a half before improvement.
What is the UKPDS, and its significance?
DM retinopathy study for DM2 patients. Found that HTN control (below 150\85). halted progression of DM retinopathy by a third, and moderate sight loss by 50%.
What is the ETDRS, and its significance?
DM retinopathy study - high cholesterol increases hard exudates occurrence X2 over.
What is the ACCORD, and its significance?
DM retinopathy study - balancing all factors. HbA1C control had the most significant effect. No effect in HTN control below 140 SBP (120 vs. 140).
HIghest mortality in the strictest control group.
PDR treatment?
Go away PeR-VerT!
PeR - PRP
VerT - Vitrectomy
VEGF in normal concentration causes ____ and in high concentrations causes _____.
healthy blood vessels, pathologic blood vessels
Anti VEGF is injected at ______, every ______, preceding an ______
Pars plan (6 mm from the limbus), every 4-6 weeks, OCT
Treatment with Anti VEGF can lead to _______
improvement of 10 letters.
AR of PRP are?
Not a FAN!
F - Field (visual feid decrese)
A - Acuity (blurness due to macular edema)
N - Near-sight decrease (damage to long ciliary nervs)
AR of PRP are?
Not a FAN!
F - Field (visual feid decrese)
A - Acuity (blurness due to macular edema)
N - Near-sight decrease (damage to long ciliary nerves)
Mild hypertensive retinopathy results in____.
arteriovenous nicking, narrowing of vessels, and opacification of the arteriolar walls.
Moderate hypertensive retinopathy results in____.
Flam, Blot, Cotton wool spots.
Severe hypertensive retinopathy results in____.
Optic disc swelling -> AION/CRAO
EMERGENCY!
____(3)____ are more common in hypertensive retinopathy
Hypertensive retinopathy - Flam, Blot, Cotton wool spots.
May also present with hard exudates
____2____ are more common in DM retinopathy.
DM retinopathy - hard exudates, microaneurysms.
May also present with: Flam, Blot, Cotton wool spots.
CRAO etiologies:
SHIT-E (shitty) S - spasm H - Hypertension of the EYE (Glaucoma/Hypertensive retinopathy) I - Inflammation (temporal arteritis) T - Thrombus E - Emboli
CRAO signs:
CMV:
C - Cherry red spot/Cow trucks
M - Marcus gun pupil
V - visual acuity
CRVO etiologies:
Best Sweet Glue PATHS and CLuMMPSS the veins!
Best - Bechet
Sweet - DM
Glue - Glaucoma
P - Protines S, C deficiency A - APLA T - Trauma H - HTN S - SOL
C - Cryoglobineamia L - Leukemia u M - MM M - Macroglobineamia P - Polyciteamia Vera S - Sickle cell S - SLE
CRVO complications:
ENTRaP
E -Edema of the macula N -Neovascular glaucoma T - Traction RD R - Rubeosis iridis a P - Pigmentary changes
CRVO treatment:
Anti-vegetarian Perps! NO Laser!
Anti-vegetarian = Anti-VEGF
Perps = PRP
NO Laser! - Laser not effective
CRVO types:
Ischemic vs non-ischemic
Ischemic CRVO findings.
aCHiEVE
a C - CWS H - Hemorrhages i E - Engorged vessels V - Vision decreased E - Edematous nerve
Non-ischemic CRVO types:
Good prognosis and visions - much less aCHiEVE
BRVO treatment:
Anti-vegetarian Laser!
Anti-vegetarian = Anti-VEGF
Laser! - Laser effective (Unlike in CRVO)
