Retinal Venous Occlusions

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52 Terms

1
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external compression of the vein by an atherosclerotic artery, intraluminal thrombosis, or inflammation of the vein

what are the theorized causes of retinal vein occlusions?

2
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hypertension

what is the leading cause of retinal vein occlusions?

3
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dilated & ruptured capillaries, edema

describe the appearance of the capillaries with a retinal vein occlusion

4
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  1. abnormalities of the vessel wall

  2. abnormalities in blood viscosity/coagulation

  3. abnormalities in blood flow/velocity

what is Virchow’s triad for thrombosis in general?

5
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increased BMI & waist circumference, increased BP, higher fasting blood glucose, higher LDL/triglycerides/total cholesterol, lower HDL

what are the systemic associations with retinal vein occlusion?

6
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sudden, painless loss of vision

what is the presenting sx of a CRVO?

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increases

the risk of a CRVO _____ with increased IOP

8
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non-ischemic CRVO

  • type of CRVO

  • less severe presentation & better prognosis

  • VA is moderately reduced

  • no APD (usually)

  • VA improves to 20/40 or better in 2/3 of pts

  • less capillary non-perfusion on IVFA

  • no neovascular complications

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ischemic CRVO

  • type of CRVO

  • much more severe

  • VA is markedly reduced, usually 20/200 or worse

  • +APD

  • massive hemorrhaging in all 4 quadrants

  • severe ME & possible disc edema

  • more cotton wool spots

  • significant capillary dropout & non-perfusion on IVFA/OCTA

  • neovascularization of the iris is very common

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carotid doppler, BP & CV work-up

what should you do to manage an ischemic CRVO?

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BP & CV workup

what should you do to manage a non-ischemic CRVO?

12
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anti-VEGF injections, intravitreal steroid implants/injections, PRP

what is the tx for a CRVO?

13
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can permanently fix the problem (decreases oxygen demand below the needed threshold)

what is the advantage of PRP for a CRVO w/ neovascularization over just anti-VEGF injections?

14
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ERM formation, night vision loss, peripheral vision loss, longer tx sessions

what are the disadvantages of PRP tx for a CRVO w/ neovascularization over just anti-VEGF injections?

15
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low rate of SE, work very well

what is the advantage of anti-VEGF injections for a CRVO w/ neovascularization?

16
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requires repeated injections (issues with cost, transportation, visit fatigue)

what is the disadvantage of anti-VEGF injections for a CRVO w/ neovascularization?

17
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endophthalmitis, elevated IOP

what are the SE of anti-VEGF injections?

18
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BRVO

  • rarely ischemic, more commonly non-ischemic

  • VA compromised only if edema/blood reaches the macular or there is long-term macular ischemia

  • neovascularization is more rare

  • usually temporal

19
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collaterals

form over 6-24mo w/ a BRVO/CRVO then often regress & close, thicker & ropey vessels

20
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anti-VEGF w/ early loading doses then tx & extend

what is the standard of tx for a BRVO w/ macular edema?

21
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monitor w/o tx

what is the standard of tx for a BRVO w/o macular edema?

22
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grid/focal laser therapy, steroid implants/injections, evaluate BP, CV workup

what are additional tx options after anti-VEGF injections for a BRVO?

23
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papillophlebitis

  • may be an inflammatory variant of a CRVO

  • often strikes at a younger age

  • disc edema typically out of proportion w/ retinal hemorrhaging, 4 quadrant hemorrhaging out to the periphery

  • condition is self limiting over the course of several months & complete recovery is the norm

  • can be related to APA syndrome

24
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  1. vague prodrome of scintillating, colored lights w/ visual disturbances

  2. enlarged blind spot on visual field

  3. mild VA reduction (20/30)

  4. dilated/tortuous veins

what are some presenting signs/sx of papillophlebitis?

25
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hypoperfusion syndrome

occurs when the eye lacks blood perfusion secondary to carotid artery blockage or ophthalmic artery blockage

26
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  1. complaint of dull, chronic ache in affected eye

  2. difficulty w/ light/dark adaptation

  3. TIA sx (amaurosis fugax)

  4. possible bruit/decreased pulse strength in carotid

  5. peripheral dot/blot hemorrhages

  6. dilated veins

  7. relatively spares posterior pole

what are some signs/sx of hypoperfusion syndrome?

27
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  1. neovascularization

  2. iritis

  3. sluggish pupil

  4. conjunctival congestion

  5. corneal edema

  6. severely reduced VA

  7. complaint of dull/chronic ache in affected eye

  8. difficulty w/ light/dark adaptation

  9. TIA sx (amaurosis fugax)

  10. possible bruit/decreased pulse strength in carotid

  11. peripheral dot/blot hemorrhages

  12. dilated veins

what are the signs/sx of ocular ischemic syndrome?

28
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  1. question about TIA

  2. check carotids

  3. arrange for carotid testing

  4. ESR

  5. C-reactive protein

  6. CBC

  7. lipid panel

when presented w/ the ocular findings of OIS or hypoperfusion, what things should you consider doing?

29
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  1. systemic management

  2. PRP/cryotherapy/anti-VEGF injections

what is the tx of OIS?

30
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ischemic CRVO

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ischemic CRVO

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non-ischemic CRVO

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hemicentral RVO w/ collaterals

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combined CRAO/CRVO

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collaterals & sclerosed vein post occlusion

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collaterals

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collaterals

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collaterals

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collaterals

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BRVO S/P laser tx

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papillophlebitis

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papillophlebitis

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papillophlebitis

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papillophlebitis

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papillophlebitis

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papillophlebitis

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papillophlebitis

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hypoperfusion syndrome

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OIS

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NVI

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Non-ischemic CRVO

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Hemicentral RVO

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