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OD3 (S1&2) > DIS - Basic Pathology: Vascular I - Week 9 > Flashcards

DIS - Basic Pathology: Vascular I - Week 9 Flashcards

1
Q

What kind of artery system is the vascular supply to and from the eye? What does this mean for collateral supply?

A

It is an end-artery system
No collateral supply

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2
Q

List the major arteries leading to the three main ocular arteries (6) beginning with the aorta.

A

Common carotid
Internal carotid
Ophthalmic
-central retinal artery
-short posterior ciliary artery
-ciliomacular artery

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3
Q

Where does the central retinal vein drain to? What does that drain to?

A

Cavernous sinus
Internal jugular

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4
Q

List the two main types of occlusions for arteries and veins (ocular). Can a combination of artery and vein occlusions occur?

A

Central and branch retinal vein occlusion
Central and branch retinal arterial occlusion
-combined is possible

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5
Q

List the two types of central retinal vein occlusion. List other names they have if applicable (2).

A

Ischaemic
Non-ischaemic
-partial
-venous stasis retinopathy

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6
Q

List the five types of branch retinal vein occlusions and note whether they are major or minor if applicable.

A

Hemi-central
1st order (major)
2nd order - after the first crossing (minor)
-macula or peripheral (after the third crossing or more)
-macula or macula sparing

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7
Q

Describe the components of virchows triad and what it leads to. Does it apply only to the retinal vessels?

A

Altered blood flow
Endothelial injury
Hypercoagulability
Interaction between these three main factors leads to thrombosis
Applies to all other vessels, not just retinal

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8
Q

List four diseases that can cause endothelial damage.

A

Hypertension
Diabetes
Atherosclerosis
Vasculitis

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9
Q

List two things that can result in venous stasis in the retina.

A

Glaucoma
Carotid flow

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10
Q

Lidt four things that can cause hypercoagulability.

A

Lupus anticoagulant
Hyperhomocysteinaemia
Factor V leidin mutation
Protein s or c deficiency

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11
Q

Define central retinal vein occlusion. What landmark does it usually occur at and at what age?

A

Acute obstruction of the vein lumen
Usually at the lamina cribrosa
Usually >65yoa

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12
Q

What kind of disease is CRVO essentially? Why is this so?

A

An arterial disease
-shared adventitia of artery and vein

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13
Q

Describe the role of increased IOP in CRVO (3).

A

Increased IOP
Backward bowing of the lamina
Pressure on the vein
-turbulent blood flow etc

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14
Q

What is the main risk factor for CRVO? List 9 additional risk factors.

A

Systemic hypertension
Age
Diabetes
Hyperlipidaemia
Smoking
Obesity
Increased IOP
Hyperviscosity conditions
Thrombophilic disorders
Oral contraceptives

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15
Q

What two things can give a moderate decrease to the risk of CRVO?

A

Physical activity
Moderate alcohol consumption

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16
Q

What percentage of all CRVO cases is ischaemic?

A

20%

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17
Q

How does ischaemic CRVO affect vision and is pain involved? How quickly is vision lost?

A

Marked visual loss with no pain
Vision is lost quickly

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18
Q

How does non-ischaemic CRVO affect vision and is pain involved? How quickly is vision lost?

A

Less obvious vision loss but is painless
Vision is lost more slowly

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19
Q

What percentage of non-ischaemic CRVO cases will convert to ischaemic CRVO?

A

20%

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20
Q

Is RAPD present with Ischaemic CRVO? What happens with greater ischaemia?

A

Yes, worse with greater ischaemia

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21
Q

What do the veins look like in ischaemic CRVO?

A

Dilated and tortuous

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22
Q

Where on the retina would you expect to see haemorrhages with ischaemic CRVO? Especially what region? What kind of haemorrhage (2)?

A

The entire fundus, especially the posterior pole
Would see dot/blot and flame haemorrhages

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23
Q

List 5 clinical features you would expect to see with ischaemic CRVO.

A

Dilated/tortuous veins
Retinal haemorrhages
Retinal oedema
Cotton wool spots
Optic disc oedema

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24
Q

What can occur later with ischaemic CRVO? What percentage of cases will develop this? How do a and b waves appear on an ERG with this?

A

Development of new vessels and/or collaterals
ERG - normal a wave, decreased b wave amplitude
35% of cases will develop this

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25
Q

Is RAPD present with non-ischaemic CRVO?

A

It may or may not be present

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26
Q

How do veins generally appear in non-ischaemic CRVO?

A

Variable, dilated, tortuous

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27
Q

What are haemorrhages like with non-ischaemic CRVO? In what region are they worse and what types would you expect to see (3)?

A

Scattered, variable number
Worse in the periphery
Dot/blot/flame haemorrhages

28
Q

Is there retinal oedema with non-ischaemic CRVO? What about optic disc oedema?

A

Yes to both

29
Q

Is new vessel growth likely with non-ischaemic CRVO? What is the ERG like?

A

New vessels less likely
ERG normal?

30
Q

What can CRVO be confused with?

A

Diabetic retinopathy

31
Q

List three features of angiography in ischaemic CRVO. Where would you expect to see staining? Where especially would you expect to see leakage (2)?

A

Delay in filling
Leakage (especially at the macula and disc)
Capillary non-perfusion
Staining of the vein wall

32
Q

Compare angiography in non-ischaemic CRVO to ischaemic CRVO (2).

A

Smaller
Capillary non-perfusion

33
Q

List five differential diagnoses for CRVO.

A

Severe diabetic retinopathy
Ocular ischaemic syndrome
Retinitis
Coats disease
Benign intracranial hypertension
-pseudotumour cerebri

34
Q

What percentage of untreated CRVO gets better and worse?

A

10-20% improves
35-50% gets worse

35
Q

Within what timeframe do most acute signs of CRVO resolve?

A

Over 9 to 12 months

36
Q

List 5 residual signs that may be left over with CRVO.

A

Haemorrhage
Disc collaterals
Sheathing of blood vessels
Pre-retinal fibrosis/epiretinal membrane
Macular pigmentary changes

37
Q

What will develop in 50% of CRVO cases and within what timeframe? What is it known as and what is it a result of?

A

Rubeosis
-within 2 to 4 months
The 90 day glaucoma
Result of VEGF release

38
Q

How should CRVO be referred, ischaemic and non-ischaemic? What is required and especially for what age population?

A

Refer all new cases, both types
Refer for a medical workup - especially young patients
-determine co-morbidities

39
Q

List a treatment option to improve VA following CRVO.

A

There is no proven treatment

40
Q

List 5 treatment options for CRVO.

A

Systemic fibrinolysis
Retinochoroidal anastamosis
Macular grid photocoagulation
Decompression of the CRV at the lamina cribrosa
Intravitreal triamcinolone

41
Q

Describe the outcome of macular grid photocoagulation as a treatment option for CRVO.

A

Improves angio, but no improvement to VA

42
Q

What is considered to be the best course of action for CRVO?

A

Anti-VEGF

43
Q

Discuss what new treatment options can offer for ischaemic CRVO. What is the management (2)?

A

New treatment offers little
Wait for neovascular changes and begin PRP when it occurs

44
Q

What is commonly the treatment for non-ischaemic CRVO (2)?

A

Intravitreal triamcinolone
Anti-VEGF injection

45
Q

What should all cases of CRVO be followed up for?

A

Neovascular glaucoma

46
Q

List 5 predictors of good anti-VEGF responses for non-ischaemic CRVO.

A

Integrity of the outer retina on OCT
Good response to 1st injection
Young
Better VA at baseline
Early intervention

47
Q

Where do BRVO tend to occur? At what age?

A

At an AV crossing
Usually >65yoa

48
Q

List the main risk factor for BRVO. List 4 additonal risk factors.

A

Hypertension
Diabetes
Hyperlipidaemia
Smoking
Renal disease

49
Q

What should you consider for venous occlusion not occuring at an AV crossing?

A

Inflammatory disease
-sarcoidosis

50
Q

What is vision loss like with BRVO? What about with a peripheral occlusion?

A

Sudden onset visual loss
Peripheral occlusion probably asymptomatic

51
Q

List four causes of VA loss with BRVO.

A

Macular oedema
Macular ischaemia
Haemorrhage at the macula
Vitreous haemorrhage 2° to NVE

52
Q

List 5 signs of BRVO.

A

Dilated/tortuous veins
Haemorrhages (dot/blot/flame)
Cotton wool spots
Retinal oedema
Vitreous haemorrhage

53
Q

What is hypofluorescence and what does it indicate?

A

Blockage of background
Capillary non-perfusion

54
Q

What does hyperfluorescence indicate?

A

Leakage

55
Q

List four differential diagnoses for BRVO.

A

CMV retinitis
Cavernous haemangioma
Periphlebitis (sarcoidosis)
Retinal macroaneurysm

56
Q

Does the acute phase of untreated BRVO resolve quickly or slowly? Over what timeframe?

A

Slowly - over 6 to 18 months

57
Q

What is the prognosis like for untreated BRVO? What is this dependent on (2)?

A

Reasonable
Dependent on venous drainage and degree of macular ischaemia

58
Q

Do haemorrhages in BRVO disappear?

A

Yes, but slowly

59
Q

What are the chances of spontaneous recovery with BRVO?

A

20 to 40%

60
Q

Is it common or rare for patients to improve to 6/12 or better vision after BRVO?

A

Rare

61
Q

How should you refer BRVO? Explain the merit in waiting.

A

Refer, especially in macular involvement
Possibly 3 months allowed for spontaneous recovery

62
Q

After what timeframe should angiography be performed in BRVO and why?

A

6 to 12 weeks after haemorrhages have cleared

63
Q

What is the treatment for macular oedema with BRVO (2)?

A

Laser photocoagulation
Can also use anti-VEGF injection (recommend to observe for 3 months first and then do after laser)

64
Q

Is a delay in anti-VEGF injection detrimental for BRVO?

A

No

65
Q

List 6 predictors of good anti-VEGF response with BRVO.

A

VA better than 6/12
Young
Retinal haemorrhage
Integrity of the outer retina with OCT
Good response to first injection
Small macular cysts

OD3 (S1&2) (114 decks)

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