BRVO

Question 1

What is BRVO?

Answer 1

Occlusion of a branch of the central retinal vein
» Major branch occlusion (hemispheric)
» Peripheral branch occlusion
» Macula branch occlusion

Question 2

what are the symptoms of BRVO?

Answer 2

with sudden onset, painless loss of vision
BUT can also be asymptomatic, depending on where occlusion occurs

-or sudden onset of blurry or distorted vision.

Depends on the extent of macula involvement
– Usually unilateral

Question 3

What are the signs of BRVO?

Answer 3

• Dilated and tortuous veins peripheral to the occlusion site
• Round/blot/flame haemorrhages
• Regional retinal oedema
• Macula oedema?
• CWS?

Question 4

What is the pathogenesis of BRVO

Answer 4

Commonly occurs at AV crossing, most likely during arteriosclerosis

Venous compression by the artery
may result in change of blood flow

endothelial damage
thrombosis
Occlusion

Question 5

What are the risk factors of BRVO?

Answer 5

HTN
CVD
Hyperlipidaemia
diabetes
glaucoma
hardening of the arteries (called arteriosclerosis)

inflammatory conditions (sarcoidosis,lyme disease)

Question 6

Investigations

Answer 6

OCT
FA
Dilated volk assesment
fundus photography

Question 7

What do the symptoms and VA of BRVO depend on?

Answer 7

1. depends on location of occlusion
2. macula involved=sudden painless onset of blurred vision and metamorphopsia

3.peripheral occlusion= asymptomatic

Question 8

What are the signs of BRVO complications

Answer 8

Macula:
Chronic macular oedema (main cause of reduced VA)
Haemorrhages
Exudates
epiretinal membrane
—–
Neovascularisation – at disc (NVD) or elsewhere (NVE)
———-
large areas of retinal ischaemia → Vitreous haemorrhage
——-
Rarely, retinal detachments (rhegmatogenous, tractional)

Question 9

what are the 2 main complications of BRVO?

Answer 9

Chronic macula oedema (>6 months)
– Neovascularisation (NVE, NVD)

Question 10

What is the management of BRVO?

Answer 10

ROUTINE referral
– To GP
– To ophthalmology

URGENT =
If significant macular involvement

Question 11

What to the GP do?

Answer 11

GP:

➢ Investigate underlying cause
-monitor
➢ Treat underlying disease, address risk factors

Question 12

What can opthalmologists do?

Answer 12

➢ FFA, OCT
➢ Regular follow-up to detect onset of any complications
* Treat any macula oedema or neovascularisation as for CRVO

Question 13

What are some indications someone need to be seen by opthamologist?

Answer 13

Ophthalmic implications:
Macular oedema
Neovascularisation – retinal & glaucoma New vessel growth (retinal and anterior eye)
Urgent referral to HES: Px should be seen by Ophthalmologist within 2-4 weeks

Question 14

What is the treatment for BRVO if there is significant macular oedema?

Answer 14

laser photocoagulation
Steroid injections / implants
Anti-VEGF injections

Question 15

What is the treatment of BRVO if there is Neo vas?

Answer 15

Neovascularisation (retinal and iris/anterior eye):

Laser retinal photocoagulation
used to treat new vessels in iris / angle and retina

Evidence that anti-VEGF therapy + photocoagulation

Question 16

What is the treatment of BRVO if there is Neo vas glaucoma?

Answer 16

Caused by new vessels on iris or angle blocking drainage

If longstanding and reduced VA, aim is to alleviate pain → topical steroids and atropine
If VA not reduced, control IOP with drops/surgery

Question 17

What is the prognosis of BRVO?

Answer 17

Acute features usually resolve within 6-12 months
Residual features:
– Venous sheathing and sclerosis
– Haemorrhages/MAs/hard exudates
– Collateral venous channels
– RPE changes at the macula
* Vision recovers to 6/12 or better in most cases unless complications

Question 18

What is the differential diagnosis?

Answer 18

diabetic retinopathy
hypertensive retinopathy

Question 19

Answer 19

Question 20