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Retinal Vascular occlusion
- 1. RETINAL VASCULAR OCCLUSIONS Retinalvein occlusion • Branch • Central • Hemi-retinal Retinal artery occlusion • Branch • Cilio-retinal • Hemi-retinal • Central
- 2. Retinal vein occlusion- predisposing factors 1. Systemic • Raised intraocular pressure 2. Ocular • Periphlebitis • Increasing age • Hypertension • Diabetes • Abnormalities of coagulation
- 3. Patho-physiology of venousocclusion Venous Occlusion Stagnation Increased extravascular pressure Hypoxia Oedema and haemorrhage
- 4. Branch retinal veinocclusion ( BRVO ) • Venous tortuosity and dilatation • Flame-shaped and ‘dot-blot’ haemorrhages • Cotton-wool spots and retinal oedema Prognosis - VA 6/12 or better after 6 months in 50% Complications - chronic macular oedema and neovascularization Signs of acute BRVO
- 5. FA of branchretinal vein occlusion Early - blocked background fluorescence due to haemorrhage Late - hyperfluorescence due to diffuse oedema
- 6. Signs of oldbranch retinal vein occlusion Vascular sheathing and collaterals Hard exudates
- 7. Management of chronicmacular oedema • Most common cause of persistent poor VA • Wait 6-12 weeks and perform FA Macular non-perfusion - no treatment Good macular perfusion and VA 6/18 or worse after 3 months - consider laser photocoagulation
- 8. Management of neovascularization •Perform laser photocoagulation to involved segment• Most frequently after 6-12 months • Occurs in about 30-50% of eyes
- 9. Central retinal veinocclusion ( CRVO ) • Chronic macular oedema • Variable cotton-wool spots • Mild to moderate disc oedema • May subsequently convert to ischaemic • Guarded prognosis • VA > CF • APD - mild • Mild venous tortuosity and dilatation • Mild to moderate retinal haemorrhages Signs of non-ischaemic CRVO
- 10. FA of non-ischaemiccentral retinal vein occlusion Good retinal capillary perfusion
- 11. Signs of ischaemiccentral retinal vein occlusion • Variable cotton wool spots • Severe disc oedema • Very poor prognosis • Macular ischaemia • Rubeosis irides in 50% • VA < 6/60 • APD - marked • Marked venous tortuosity and engorgement • Extensive retinal haemorrhages
- 12. FA of ischaemiccentral retinal vein occlusion Extensive capillary non-perfusion
- 13. Management of ischaemiccentral retinal vein occlusion • Check every month for 6 months • Look for rubeosis and angle new vessels • Treat neovascularization by panretinal photocoagulation
- 14. Hemi-retinal Vein Occlusion •VA< reduction is variable • Signs of BRVO • Superior or inferior hemisphere involve
- 15. FA Hemi-retinal VeinOcclusion
- 16. Management of CRVO •Radial Optic Neurotomy • A-V sheathotomy • Chorio-retinal anastomosis • Laser • Surgical • IVTA • Anti-VEGF
- 17.
- 18. Causes of retinalartery occlusion Embolism Vaso-obliteration
- 19. Cholesterol emboli (Hollenhorstplaques) • Multiple, bright, refractile crystals • Often located at arteriolar bifurcations • Frequently asymptomatic
- 20. Fibrinoplatelet emboli • Multiple,dull grey particles • Occasionally fill entire lumen • May cause amaurosis fugax and occasionally permanent obstruction
- 21. Calcific emboli • Usuallysingle, white and close to disc • May cause permanent obstruction
- 22. Branch retinal arteryocclusion ( BRAO ) • VA - variable • APD - mild or absent • Retina whitening • Arteriolar narrowing
- 23. FA of branchretinal artery occlusion Early masking Extreme delay of arterial phase Late staining of arterial walls
- 24. Cilioretinal artery occlusion •Present in about 30% of individuals • In young individuals with a systemic vasculitis • Guarded prognosis Combined with CRVO • Usually good prognosis • Elderly patients with giant cell arteritis • Very poor prognosis Isolated Combined with anterior ischaemic optic neuropathy • Cilioretinal artery derived from posterior ciliary circulation
- 25. Central retinal arteryocclusion ( CRAO ) • VA < 6/60 • ‘Cherry-red spot’ at macula • Arteriolar and venular narrowing • Very poor prognosis • Sludging and segmentation of blood column (cattle-trucking) • APD - marked • Retinal whitening
- 26. FA of centralretinal artery occlusion Early filling of cilioretinal artery Non-filling of other vessels Late staining of vessel walls
- 27. Treatment of centralretinal artery occlusion • Ocular massage • Sub-lingual Iso-sorbide di-nitrate • Lowering of IOP • AC paracentesis • IV Streptokinase