Vascular retinopathies

Question 1

Inner Blood Retinal Barrier is made up of _____, and its pathology is seen in _____ on FA.

Answer 1

Retinal capillaries tight-junctions, DM.

Question 2

Outer Blood Retinal Barrier is made up of _____, and its pathology is seen in _____ on FA.

Answer 2

RPE Zonula occludens, AMD.

Question 3

___% of DM patients have sight-threatening pathology, and ____% of all DM have some sort of pathology.

Answer 3

8%, 42&

Question 4

___% of DM patients that lost sight in one eye will lose it in the other in a year, and ____% in 5 years

Answer 4

60%, 90%

Question 5

Duration of DM increases the risk of DM retinopathy - ___% of DM patients under 10 years, and ____% in DM patients over 20 years

Answer 5

7%, 75%

Question 6

PDR has vessels crossing the____.

Answer 6

ILM

Question 7

Mild-Moderate NPDR findings:

Answer 7

MEH…

M - Micro-aneurysms.
E - Exudates (hard).
H - hemorrhage (dot, blot, flame).

Question 8

Circinate is ____, and its clinical significance is ______.

Answer 8

a ring of hard exudates, significant central leak.

Question 9

Severe NPDR findings:

Answer 9

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.

Question 10

Cotton wool spots are_____, and their significance is____.

Answer 10

focal ischemia and damage to NFL (axoplasmic flow damage), axons swelling.

Question 11

Hard exudates are_____, and their clinical significance is____.

Answer 11

fat and protein precipitants, edema due to damage of the inner RBB.

Question 12

On FA of NPDR patient, white spots are____.

Answer 12

Micro-aneurysms.

Question 13

On FA of NPDR patient, black areas are____.

Answer 13

hemorrhage.

Question 14

On FA of NPDR patient, it’s impossible to see____.

Answer 14

active bleeding.

Question 15

NPDR patients are usually _____.

Answer 15

asymptomatic

Question 16

NPDR patients will begin to experience symptoms with ______, and it is _____ to treat.

Answer 16

macular edema, possible.

Question 17

Macular edema is _____ to treat.

Answer 17

possible

Question 18

Ischemic maculopathy is _____ to treat.

Answer 18

not possible

Question 19

NVD stand for______, and has ______ prognosis.

Answer 19

disc neo-vascularization, poor

Question 20

NVE stand for______.

Answer 20

neo-vascularization elsewhere.

Question 21

Immediate complication of PDR is ______.

Answer 21

tearing of pathologic vessels (due to movement of Vitreous body) -> bleeding-> “black screen”.

Question 22

Later complication of PDR is ______.

Answer 22

Traction retinal detachment.

Question 23

Traction retinal detachment in PDR’s pathophysiology:

Answer 23

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.

Question 24

Rubeosis iridis is ______, and can lead to ______, and eventually _____.

Answer 24

Growth of pathologic vessels over the Iris, Vascular Glaucoma, impossible to rehabilitate.

Question 25

Severe NPDR has the ____ rule.

Answer 25

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)

Question 26

Treatment of DM retinopathy?

Answer 26

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!) ```

Question 27

What is the DCCT, and its significance?

Answer 27

DM retinopathy study for DM1 patients. Found that strict adherence and treatment halted occurrence and progression of DM retinopathy by 5 times over.

Question 28

What are the AR of the DCCT

Answer 28

Hypoglycemia and Fat gains

Question 29

Unbalanced patients starting strict Blood sugar control will experience ___________.

Answer 29

progression of DM retinopathy for a year and a half before improvement.

Question 30

What is the UKPDS, and its significance?

Answer 30

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%.

Question 31

What is the ETDRS, and its significance?

Answer 31

DM retinopathy study - high cholesterol increases hard exudates occurrence X2 over.

Question 32

What is the ACCORD, and its significance?

Answer 32

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.

Question 33

PDR treatment?

Answer 33

Go away PeR-VerT! PeR - PRP VerT - Vitrectomy

Question 34

VEGF in normal concentration causes ____ and in high concentrations causes _____.

Answer 34

healthy blood vessels, pathologic blood vessels

Question 35

Anti VEGF is injected at ______, every ______, preceding an ______

Answer 35

Pars plan (6 mm from the limbus), every 4-6 weeks, OCT

Question 36

Treatment with Anti VEGF can lead to _______

Answer 36

improvement of 10 letters.

Question 37

AR of PRP are?

Answer 37

Not a FAN! F - Field (visual feid decrese) A - Acuity (blurness due to macular edema) N - Near-sight decrease (damage to long ciliary nervs)

Question 38

AR of PRP are?

Answer 38

Not a FAN! F - Field (visual feid decrese) A - Acuity (blurness due to macular edema) N - Near-sight decrease (damage to long ciliary nerves)

Question 39

Mild hypertensive retinopathy results in____.

Answer 39

arteriovenous nicking, narrowing of vessels, and opacification of the arteriolar walls.

Question 40

Moderate hypertensive retinopathy results in____.

Answer 40

Flam, Blot, Cotton wool spots.

Question 41

Severe hypertensive retinopathy results in____.

Answer 41

Optic disc swelling -> AION/CRAO | EMERGENCY!

Question 42

____(3)____ are more common in hypertensive retinopathy

Answer 42

Hypertensive retinopathy - Flam, Blot, Cotton wool spots. May also present with hard exudates

Question 43

____2____ are more common in DM retinopathy.

Answer 43

DM retinopathy - hard exudates, microaneurysms. May also present with: Flam, Blot, Cotton wool spots.

Question 44

CRAO etiologies:

Answer 44

``` SHIT-E (shitty) S - spasm H - Hypertension of the EYE (Glaucoma/Hypertensive retinopathy) I - Inflammation (temporal arteritis) T - Thrombus E - Emboli ```

Question 45

CRAO signs:

Answer 45

CMV: C - Cherry red spot/Cow trucks M - Marcus gun pupil V - visual acuity

Question 46

CRVO etiologies:

Answer 46

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 ```

Question 47

CRVO complications:

Answer 47

ENTRaP ``` E -Edema of the macula N -Neovascular glaucoma T - Traction RD R - Rubeosis iridis a P - Pigmentary changes ```

Question 48

CRVO treatment:

Answer 48

Anti-vegetarian Perps! NO Laser! Anti-vegetarian = Anti-VEGF Perps = PRP NO Laser! - Laser not effective

Question 49

CRVO types:

Answer 49

Ischemic vs non-ischemic

Question 50

Ischemic CRVO findings.

Answer 50

aCHiEVE ``` a C - CWS H - Hemorrhages i E - Engorged vessels V - Vision decreased E - Edematous nerve ```

Question 51

Non-ischemic CRVO types:

Answer 51

Good prognosis and visions - much less aCHiEVE

Question 52

BRVO treatment:

Answer 52

Anti-vegetarian Laser! Anti-vegetarian = Anti-VEGF Laser! - Laser effective (Unlike in CRVO)