10a. Retinal Venous Occlusions
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Retinal venous occlusions affects/features/classifications?
- CRVO, HRVO, BRVO
- venous occlusion-> venous stasis-> vessel damage-> ischaemia-> haemorrhage and edema
What are the most common predisposing factors for RVOs?
old age, hypertnesion, cholesterol, diabetes, smoking, raised IOP
Pathogenosis of CRVO?
- obstruction: thrombus in CRV, arteriosclerosis of CRA-> increases flow to CRV
- OR: compressive/inflammatory ON/orbital problems (structural abnorms in lamcrib)-> lead to CRV thrombosis
pathogenosis of BRVO?
- compression of vein by crossing artery
- venous occlusion-> stasis-> ischaemia-> damage to retinal tissues-> hamemorrhage, edema
Pathogenisis of HRVO?
- variant of CRVO
- occlusion of sup/inf branch of CRV
- HCRVO: involves one trunk- congenital
What is the typical presentation of an RVO?
- uni, painless loss of VA
medical investigations for RVO?
BP, ECG, C reactive protein, chest x ray
ocular investigations for RVO?
Why and where do haemorrhages occur in CRVO?
- new vessels where supply is lost: leaky
- NVD/NVI ischaemic
Is RAPD seen in ischaemic or non ischaemic?
ischaemic- related to marked retinal pathology
Which is more common Isch or non isch CRVO?
- ischaemic CRVO: 20-30%
- non ischaemic: 80-70%
Signs of Ischaemic CRVO?
- rapid onset venous occlusion, decreased of retinal perfusion, capillary occlusion, retinal hypoxia
- sudden severe loss of vision- macula edema
prognosis of ischaemic CRVO?
- poor due to mac ischaemia
- red iris develops
TX of ischaemic CRVO?
laser to prevent NVG
What is the fundus presentation of ischaemic CRVO?
- tortuosity and engorg of CRV branches
- extensive haem
- Macular edema
Presentation of NOn-ischaemic CRVO?
sudden painless mild-mod loss of VA
Fundus presentation of non-ischaemic CRVO?
- tortous and engorgement of CRV branches
- dot blot+ flame haem
- OD and Mac edema
Prognosis of non-isch
- will resovle in 6-12m
- can convert to ischaemic CRVO
- tx inadequate
Presentation of HRVO?
- sudden onset VF defect
- ~ VA down
Signs of HRVO?
inf/sup BRVO chnages
fundus presentation of BRVO?
sup/inf fundus haemorrhages
Presentation of BRVO?
- VF defect
Fundus presentation of BRVO?
- dilation/tortu behind occlusion
- flame/dotblot haem
- retinal edema
- sector of retina
Prognosis of BRVO?
- collateral vessles-> bypass
What are vision threatening complications of BRVO
- macular edema- VA
- macular ischaemia
1st line management of RVO macula edema?
intravitreal anti VEGF
frequency of RVO?
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