RETINA - VASCULAR RETINOPATHIES Flashcards
(42 cards)
what are the 3 types of plaques? What is the site of origin for each?
- Fischer plaque - carotid origin
- Hollenhorst (carotid) plaque - carotid origin
- Calcific plaque - aortic /mitral valve origin
which plque is the most common of the 3?
Hollenhorst plaque
Which one appears at vessel bifurcations as a yellow spot?
Hollenhorst plaque
Which plaque is the most dangerous of the 3? why?
Calcific plaque - not malleable, thus can lead to complete blockage.
which plaque appears close to the ONH?
Calcific plaque
Why does a hollenhorst plaque travel further than a calcific plaque?
- Hollenhorst plaque is small, mallable and can easily break and travel further.
- Calcific plaque are bigger and not malleable thus harder to break and which keeps it at a closer location.
what is a CRAO? what plaque is associated with CRAO?
- CRAO is occlusion of the central retinal artery.
- associated with hollenhorst or calcific plaques (most common).
what systemic Dz are associated with CRAO/BRAO (in order from greatest)?
HTN > DM > Cardiac Dz > Carotid Dz
what are some signs of CRAO?
- pale retina
- cherry red spot
- chronic - whitening is resolved.
- optic disc pallor
what are symptoms of CRAO?
- acute, painless unilateral vision loss
- amaurosis fugax
what is a BRAO? what plaque is associated with a BRAO? why?
- occlusion of a branch of the central retinal artery.
- hollenhorst plaque - b/c it is smaller thus travels further.
what are signs of BRAO?
- one quadrant will be pale.
- permanent VF defect
what other condition must be r/o in someone with CRAO/BRAO?
GCA
how to tx/manage CRAO/BRAO?
tx is aimed at reducing eye pressure:
* hypervetilation into paper bag
* digital massage
* systemic acetazolamide (diamox)
* topical hypotensive gtts (timolol) x15minutes
* paracentesis
monitor regularly - to check for neo - if neo then PRP or anti-VEGF injections.
urgent referral to PCP - have higher risk of heart attack and stroke.
what is CRVO? what causes a CRVO?
- occlusion of the central retinal vein of the retina.
- caused by a thrombus that forms w/in the Central Retinal Vein.
what is a BRVO? what causes a BRVO?
- Occlusion one of the branch retinal veins.
- caused by a thrombus that forms in one of the small retinal veins prior to drainage into the central retinal vein.
what systmic Dz are are associated with CRVO/BRVO?
HTN > DM > cardiovascular Dz > POAG.
younger pts - oral contraceptives.
what are the signs of CRVO/BRVO?
- blood & thunder - hemes (flame hemes) / exudates / cws.
- dilated tortuous veins
- optic disc or/and macular edema.
- chronic - collateral vessels.
- serious - neovascularization of iris –> 90 day glaucoma.
CRVO - signs in all quadrants.
BRVO - signs in one quadrant (mainly superior temporal).
what are symptoms of CRVO/BRVO?
- sudden, painless, unilateral vision loss.
- amaurosis fugax.
- pain, if neo.
tx for CRVO/BRVO?
- no tx indicated unless there is edema or neo –> if edema/neo - tx w/ PRP/anti-VEGF
- monitor monthly for the 1st 6 months to check for edema or 90-day glaucoma.
- urgent referral to PCP for full cardiac eval.
- d/c oral contraceptives
- take aspirin prophylactically.
what is the % of those that may develop CRVO/BRVO in the fellow eye?
7%
what is OIS?
hypoperfusion of the anterior and posterior segments of the eye due to carotid obstructive disease (internal carotid artery is 90% blocked due to plaque build-up).
what is epidemiology for OIS?
- M >F
- > 50 yrs
systemic associations of OIS (greatest >least)
HTN > DM > cardiac > GCA.
- suspect cardiac DZ - #1 cause of mortality.
