Central Retinal Vein Occlsion (CRVO)

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  • Must tell the reliability of each test
  • Central Retinal Vein Occlsion (CRVO)

    1. 1. RETINAL VEIN OCCLUSION Dr. Yousaf Jamal FCPS Resident Ophthalmology Unit Hayatabad Medical Complex 18/12/10 Mar 25, 2013
    2. 2. Contents• Introduction of RVO• CRVO – Demographics – Pathogenesis – Etiology – Management • Hx, examination, investigation • Treatment – Trials – Guidelines• Summary / Take Home Message• MCQs Page 2 Retinal Vein Occlusion Mar 25, 2013
    3. 3. Introduction• Common vascular disorder• Second common cause of blindness after diabetic retinopathy• Cause…obstruction to venous flow• Associated risk factors….multifactorial• Classification – Site of involvement – Extent of retinal perfusion Page 3 Retinal Vein Occlusion Mar 25, 2013
    4. 4. Demographics• In Australia, prevalence of RVO… – 0.7% in pts aged 49-60 years to 4.6% in pts older than 80 years a• Seasonal variation found…greater than 20,000 patients in the month of January ba Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. Oct 1996;114(10):1243-7b Ho JD, Tsai CY, Liou SW, et al. Seasonal variations in the occurrence of retinal vein occlusion: a five-year nationwide population- based study from Taiwan. Am J Ophthalmol. Apr 2008;145(4):722-728.  Page 4 Retinal Vein Occlusion Mar 25, 2013
    5. 5. Common mechanism Venous blockage back pressure on capillaries endothelial junction dysfunction leakage of fluid & blood (edema / hemorrhages)• Severe nonperfusion leads to ischemia Page 5 Retinal Vein Occlusion Mar 25, 2013
    6. 6. Predominant associationsPatient Hypertensio Hyperlipidemia Diabetes No Obvious Group n Mellitus CauseAge<50 25% 35% 03% 40% yrsAge>50 64% 34% 4-15% 21% yrs Asian 64% 50% 29% 10.7% West 83% 33% 38% 8.3% IndianRecurren 88% 47% 3% 6% t cases• Royal college of ophthalmologists guidelines: Feb. 2009 Page 6 Retinal Vein Occlusion Mar 25, 2013
    7. 7. Classification• Central retinal vein occlusion (CRVO) – Non-ischemic CRVO – Ischemic CRVO• Branch retinal vein occlusion (BRVO) – Major BRVO – Macular BRVO• Hemicentral retinal vein occlusion (HCRVO) – Non-ischemic HCRVO – Ischemic HCRVO Page 7 Retinal Vein Occlusion Mar 25, 2013
    8. 8. Central retinal vein occlusion• Painless loss of vision• Site: occlusion at or posterior to lamina cribrosa• Two clinical types – Ischemic CRVO (I-CRVO) – Non-ischemic (NI-CRVO)• ‘Research into CRVO is fraught with challenges, from accurate disease classification to its treatment; even the most prestigious trials have become controversial’• Madhusudhana KC, Newsom RS.Central retinal vein occlusion: the therapeutic options. Can J Ophthalmol.Apr 2007;42(2):193-5. Page 8 Retinal Vein Occlusion Mar 25, 2013
    9. 9. Demographics• Prevalence = 0.1% a - 0.5% b• 15-year cumulative incidence of CRVO to be 0.5% c• NI-CRVO more common than I-CRVO• No racial predilection• Men > women• >90% CRVO occurs in > 50 yrs agea Klein R et al. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study.Trans Am Ophthalmol Soc 2000;98:133– 41.b Mitchell Pet al. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol 1996;114:1243–7.c Klein R et al. The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study. Arch Ophthalmol. Apr 2008;126(4):513-8. Page 9 Retinal Vein Occlusion Mar 25, 2013
    10. 10. Pathogenesis• Virchow triad: – Loss of vessel wall integrity – Altered blood flow – Hypercoagulable state• Disturbance leads to thrombus formation & vessel occlusion Page 10 Retinal Vein Occlusion Mar 25, 2013
    11. 11. • Klein & Olwin postulated: – Compression of vein by sclerotic central retinal artery – Occlusion by primary vessel wall disease (degenerative or inflammatory) – Hemodynamic disturbance Klein BA, Olwin JH. A survey of the pathogenesis of retinal venous occlusion. Arch Ophthalmol 1956;56:207. Page 11 Retinal Vein Occlusion Mar 25, 2013
    12. 12. Page 12 Retinal Vein Occlusion Mar 25, 2013
    13. 13. CRVO resistance to venous flow blood stagnation & ischemia stimulates production of VEGF (vascular endothelial growth factor)neovascularization capillary leakage (edema) Page 13 Retinal Vein Occlusion Mar 25, 2013
    14. 14. Page 14 Retinal Vein Occlusion Mar 25, 2013
    15. 15. Etiology• Any factor which directly or indirectly activates virchow triad…. Page 15 Retinal Vein Occlusion Mar 25, 2013
    16. 16. External compression – Arteriosclerosis of CRA (HTN, DM, Hyperlipidemia) – Glaucoma (5 times more likely to have CRVO) – Papilledema – Thyroid eye disease – Orbital space occupying lesions – Cavernous sinus thrombosis – Closed-Head trauma – Retrobulbar injections * * Morgan et al. ocular complications associated with retrobulbar injections. Ophthalmology 1988;95:660.Page 16 Retinal Vein Occlusion Mar 25, 2013
    17. 17. Disease of vessel wall – Systemic Vasculitis • TB • AIDS • Syphilis • SLE – Localized inflammation • Sarcoidosis • Serpiginous choroiditis ** Bluemenkranz et al. atypical serpiginous choroiditis. Arch ophthalmol 1773;1982:100. Page 17 Retinal Vein Occlusion Mar 25, 2013
    18. 18. Hematological disorders• Clotting disorders • Paraproteinemia – Activated protein C – Multiple myeloma resistance – Cryoglobulinemia – Lupus anticoagulant • Drugs deficiency – Oral contraceptive – Anticardiolipin antibodies – Diuretics – Protein C & Protein S deficiency • Blood dyscrasia – Antithrombin III def – Lymphoma – Antiphospholipid – Leukemia antibodies – Polycythemia vera• Nephrotic syndrome – Sickle cell disease Page 18 Retinal Vein Occlusion Mar 25, 2013
    19. 19. MANAGEMENTPage 19 Retinal Vein Occlusion Mar 25, 2013
    20. 20. History• Symptoms – Painless loss of vision (mild to severe) – Usually unilateral• Past & Personal Hx – HTN, DM, smoking – Hyperlipidemia – Bleeding or clotting disorders – Glaucoma – Oral contraceptive use – Head trauma / retrobulbar inj Page 20 Retinal Vein Occlusion Mar 25, 2013
    21. 21. Examination – VA & BCVA – Pupillary reactions – Congestion of conjunctiva or cornea – Iris…neovessels – AC angle…neovessels – IOPPage 21 Retinal Vein Occlusion Mar 25, 2013
    22. 22. • Fundus findings – Retinal hemorrhages in 4 quadrants – Extensive hemorrhages…blood & thunder appearance – Dilated tortuous veins – Cotton wool spots, macular edema – Optic disc • Edema / optociliary shunts / atrophy – Neovessels • NVD / NVE……vitreous hemorrhage Page 22 Retinal Vein Occlusion Mar 25, 2013
    23. 23. Page 23 Retinal Vein Occlusion Mar 25, 2013
    24. 24. • Diagnosing CRVO is not difficult• Main task…differentiate btw ischemic & non- ischemic CRVO• No single criterion is helpful• Various useful tools… – Visual acuity, pupillary reflex – Ocular neovascularization, Fundus findings – Perimetry, ERG, FFA Page 24 Retinal Vein Occlusion Mar 25, 2013
    25. 25. Non-Ischemic IschemicFrequency 75-80% 20-25% VA better than 6/60 Worse than 6/60 RAPD Slight or nil MarkedVF defect rare Common Fundus Less hemorrhages & Extensive hemorrhages & cotton wool spots cotton wool spots FFA Good perfusion Non-perfusion > 10 DD ERG Normal Reduced b-wave amplitude, reduced b:a ratioPrognosis 50%...6/60 or better 60%...Rubeosis & NVG Page 25 Retinal Vein Occlusion Mar 25, 2013
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    29. 29. Complications• Principle causes of visual morbidity – Macular edema (ME) – Neovascularization (NVI>NVD>NVE) & Neovascular glaucoma (100 days) – Vitreous hemorrhage – Optic atrophy Page 29 Retinal Vein Occlusion Mar 25, 2013
    30. 30. Differential diagnosis• Ocular ischemic syndrome• Diabetic retinopathy• Papilledema• Radiation retinopathy• Retinopathy due to anemia Page 30 Retinal Vein Occlusion Mar 25, 2013
    31. 31. Ocular Investigations• ERG – Reduced b-wave amplitude – reduced b:a ratio – b:a ratio < 1 suggests an I-CRVO• OCT – For macular thickness Page 31 Retinal Vein Occlusion Mar 25, 2013
    32. 32. • Fluorescein angiography – Very useful for detecting… • Capillary nonperfusion • Neovascularization • Macular edema – Reliable to differentiate btw I-CRVO & NI-CRVO – >10 DD retinal nonperfusion is termed as I-CRVO* * The Central Vein Occlusion Study Group A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion: The Central Retinal Vein Occlusion Study Group N Report. Ophthalmology 1995;102: 1434-44. Page 32 Retinal Vein Occlusion Mar 25, 2013
    33. 33. – Limitations • It provides little information in early stages bcz of extensive hemorrhages • Poor quality of angiograms • Inability to visualize peripheral retina • Interpretation is subjective & hence variablePage 33 Retinal Vein Occlusion Mar 25, 2013
    34. 34. • FFA findings – Delayed arteriovenous transit – Macular edema – Staining along the retinal veins – Micro aneurysms, Arteriovenous collaterals – NVD, NVE – Dilated optic nerve head capillaries – Nonperfusion…hypofluorescence Page 34 Retinal Vein Occlusion Mar 25, 2013
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    39. 39. Systemic investigations• IT IS THE RESPONSIBILITY OF THE OPHTHALMOLOGICAL TEAM TO ENSURE THAT MEDICAL INVESTIGATION AND TREATMENT IS INITIATED ON DIAGNOSIS OF RETINAL VEIN OCCLUSION. Royal college of ophthalmologists guidelines: Feb. 2009 Page 39 Retinal Vein Occlusion Mar 25, 2013
    40. 40. • It is the responsibility of the diagnosing physician or ophthalmologist to: – Investigate and interpret results. – Refer the patient for appropriate medical advice with urgency according to the severity of underlying risk factor(s). – Ensure that specialists in the relevant field should manage the rarer causes of retinal vein occlusion. – Ensure that initiation of medical management occurs within 2 months of diagnosis Royal college of ophthalmologists guidelines: Feb. 2009 Page 40 Retinal Vein Occlusion Mar 25, 2013
    41. 41. Initial medical investigations• ALL PATIENTS • ACCORDING TO – FBC & ESR CLINICAL INDICATION – Renal function tests – Thrombophilia screen – Random blood glucose – Anticardiolipin antibody – Lipid profile – CRP – Plasma protein – Serum ACE electrophoresis – Autoantibodies – Thyroid function – CXR – ECG – Fasting homocystine levels Royal college of ophthalmologists guidelines: Feb. 2009 Page 41 Retinal Vein Occlusion Mar 25, 2013
    42. 42. Natural history of CRVO• NI-CRVO – Completely resolution…10% a – ME resolves…30% in 6-15 months b – About 50%...VA is 6/60 or worse a – 1/3rd progress to I-CRVO in 6-12 months a – Neovessels develop…33% in 12-15 months ba Central Vein Occlusion Study Group. Baseline and early natural history report. Arch Ophthalmol. Aug 1993;111(8):1087-95b McIntosh RL et al. Natural History of Central Retinal Vein Occlusion: An Evidence-Based Systematic Review. Ophthalmology 2010;117:1113–1123 Page 42 Retinal Vein Occlusion Mar 25, 2013
    43. 43. • I-CRVO – >90%...VA is 6/60 or worse a – ME resolves…73% in 15 months b – NVG…>60% in 1-2 yrs a – About 10% develop RVO in same or fellow eye in 2 yrs• Vitreous hemorrhage…10 % of CRVO by 9 months ba Central Vein Occlusion Study Group. Baseline and early natural history report. Arch Ophthalmol. Aug 1993;111(8):1087-95b McIntosh RL et al. Natural History of Central Retinal Vein Occlusion: An Evidence-Based Systematic Review. Ophthalmology 2010;117:1113–1123 Page 43 Retinal Vein Occlusion Mar 25, 2013
    44. 44. Treatment• Systemic treatment a – Anticoagulants…Heparin, warfarin – Fibrinolytic agents…Streptokinase, tissue plasminogen activator – Antiplatelets…Aspirin, prostacyclin – Hemodilution• No favorable effects on natural history ba Mahmood T. CRVO: current management options. Pak J Ophthalmol 2009. 25(1):56-9.b Mohamed Q et al. interventions for CRVO. an evidence-based systematic review. Ophthalmology. 2007; 114:507-19 Page 44 Retinal Vein Occlusion Mar 25, 2013
    45. 45. • Ocular treatment – Pharmacotherapy – Photocoagulation – New techniques (Surgical)• Certain clinical trials needs attention Page 45 Retinal Vein Occlusion Mar 25, 2013
    46. 46. Central Vein Occlusion Study (CVOS)• More than a decade• Purpose – To determine whether photocoagulation therapy can help prevent iris neovascularization in eyes with CVO and evidence of ischemic retina.  – To assess whether grid-pattern photocoagulation therapy will reduce loss of central visual acuity due to macular edema secondary to CVO. – To develop new data describing the course and prognosis for eyes with CVO. Page 46 Retinal Vein Occlusion Mar 25, 2013
    47. 47. • Eligible pts were divided in 4 groups: – Group N: Eyes with extensive retinal ischemia (at least 10 disc areas of nonperfusion) were randomly assigned to receive panretinal photocoagulation or no treatment unless iris neovascularization developed.  – Group M: Eyes with visual loss ascribable to macular edema were randomly assigned to receive grid-pattern photocoagulation or no treatment. The Central Vein Occlusion Study Group: Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. The CVOS Group M Report. Ophthalmol 102: 1425-1433, 1995 Page 47 Retinal Vein Occlusion Mar 25, 2013
    48. 48. – Group P: Eyes with relatively perfused retinas were followed to provide information about the natural history of the disease. – Group I: Indeterminate eyes in which the retina could not be visualized accurately because of hemorrhage were followed in a natural history study. The Central Vein Occlusion Study Group: Natural history and clinical management of central retinal vein occlusion. Arch Ophthalmol 115: 486-491, 1997.Page 48 Retinal Vein Occlusion Mar 25, 2013
    49. 49. • Green argon laser was used for all Tx• Followed for 3 yrs with photographic images• Visual acuity was primary outcome factor in macular edema group• Clarkson JG, Central Vein Occlusion Study Group: Central vein occlusion study: Photographic protocol and early natural history. . Trans Am Ophthalmol Soc 92: 203-215, 1994• The Central Vein Occlusion Study Group: Baseline and early natural history report. Arch Ophthalmol 111: 1087-1095, 1993. Page 49 Retinal Vein Occlusion Mar 25, 2013
    50. 50. • Results – Group M--Macular Edema: Macular grid photocoagulation was effective in reducing angiographic evidence of macular edema but did not improve visual acuity in eyes with reduced vision due to macular edema from CVO. – Group I--Indeterminate: Eyes with such extensive Intraretinal hemorrhage that it is not possible to determine the retinal capillary perfusion status act as if they are ischemic or nonperfused Page 50 Retinal Vein Occlusion Mar 25, 2013
    51. 51. – Group N--PRP for Ischemic CVO: Prophylactic PRP did not prevent the development of NVI in eyes with >10 disc areas of retinal capillary nonperfusion confirmed by FFA. Rather, results of this RCT demonstrate that it is safe to wait for the development of early iris neovascularization and then apply PRPPage 51 Retinal Vein Occlusion Mar 25, 2013
    52. 52. SCORE-CRVO study• Standard care vs. COrticosteroids for REtinal vein occlusion study• Funded by national eye institute in May 2003• Multicentered RCT• 271 participants SCORE study Report # 5. Arch Ophathalmol. 2009;127:1101. Page 52 Retinal Vein Occlusion Mar 25, 2013
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    62. 62. • Another major study which added to the armamentarium…CRUISE trial• CRIUSE: Anti-vascular endothelial growth factor (VEGF) therapy vs. placebo in CRVO• Rationale was… – Ischemic retina releases VEGF which leads to ME & neovascularization Campochiaro PA. CRUISE. Retina congress 2009. Page 62 Retinal Vein Occlusion Mar 25, 2013
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    71. 71. • In June 2010, the FDA approved a new indication for Ranibizumab intravitreal injection…for the treatment of macular edema after retinal vein occlusion.• FDA approved Ranibizumab after CRUISE & BRAVO trials results. http://www.medscape.com/viewarticle/724118 Page 71 Retinal Vein Occlusion Mar 25, 2013
    72. 72. The Royal College of Ophthalmologists Guidelines• Published in Feb. 2009.• Macular edema – Grid laser improves the edema but no improvement in VA… so not recommended – IVTA produce anatomical & functional improvement but effects are short lived. – Common dose of IVTA…4mg – Repeated IVTA may not improve vision.** Wang L, Song H. Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion. Acta Ophthalmol 2008 May 27. [Epub ahead of print] PMID: 18507724. Page 72 Retinal Vein Occlusion Mar 25, 2013
    73. 73. – Posurdex* in 350 or 700 µg also improves vision. – Intravitreal anti-VEGF therapy (CRIUSE) trial was going on but not published at that time. – However, now its approved by FDA for RVO.* Clinicaltrials.gov Identifier NCT 00485836/00486018 Page 73 Retinal Vein Occlusion Mar 25, 2013
    74. 74. • Anterior segment neovascularization – I-CRVO should be monitored monthly for new vessels at iris &/or angle – Pan-retinal photocoagulation is advised when NVI or NVA are visible – If logistically not possible…2-3 months follow-up is adequate Page 74 Retinal Vein Occlusion Mar 25, 2013
    75. 75. – If regular follow-up not practical…prophylactic treatment is appropriate a – IVTA…no proven protective effect on anterior neovascularization – Anti-VEGF can be used as an adjuvant to PRP in pts with anterior segment neovascularization secondary to I-CRVO ba Laatikainen, L. A prospective follow-up study of panretinal photocagulation in preventing neovascular glaucoma following ischaemic central retinal vein occlusion. Graefe’s Arch Clin Exp Ophthalmol 1983; 220:236-239.b Davidorf FH, Mouser JG, Derick RJ. Rapid improvement of rubeosis iridis from a single bevacizumab (Avastin) injection. Retina 2006; 26(3):354-6. Page 75 Retinal Vein Occlusion Mar 25, 2013
    76. 76. • Established neovascular glaucoma – Aim…keep eye pain free. • Topical steroids • Atropine – If there’s visual potential • Topical pressure lowering agents • Cycloablation – Intravitreal and Intracameral anti-VEGF show regression of iris vessels & angle obstruction Page 76 Retinal Vein Occlusion Mar 25, 2013
    77. 77. Experimental treatments – Chorio-retinal anastomosis – Radial optic neurotomy with PPV a – Thrombolytic therapies b• Currently…these are not recommended except as a part of clinical trialsa Arevalo JF et al ;Pan-American Collaborative Retina Study Group. Radial optic neurotomy for central retinal vein occlusion: results of the Pan-American Collaborative Retina Study Group (PACORES). Retina 2008; 28(8):1044-52.b Murakami T et al. Role of posterior vitreous detachment induced by intravitreal tissue plasminogen activator in macular edema with central retinal vein occlusion. Retina 2007; 27(8):1031-7. Page 77 Retinal Vein Occlusion Mar 25, 2013
    78. 78. Recommendations for further follow-up• Follow-up after 6 months for ischemia should be every 3 months for 1 year• Non-ischemic eyes…every 3 months for 6 months.• Subsequent follow-up will depend on laser Tx & complications.• Development of disc collaterals +/- resolution of CRVO should lead to discharge from clinical supervision Page 78 Retinal Vein Occlusion Mar 25, 2013
    79. 79. SUMMARYPage 79 Retinal Vein Occlusion Mar 25, 2013
    80. 80. Summary• CRVO…potentially blinding• Local & systemic risk factors• Young pts need special workup• Many treatment options…difficult to decide• Guidelines are helpful Page 80 Retinal Vein Occlusion Mar 25, 2013
    81. 81. Take home message• Emphasis should be on: – Differentiating ischemic & Nonischemic CRVO – Exploring the risk factors (local & systemic) – Treating CRVO and Referral to physician for risk factors – Proper follow-up Page 81 Retinal Vein Occlusion Mar 25, 2013
    82. 82. THANKSPage 82 Retinal Vein Occlusion Mar 25, 2013
    83. 83. MCQs1. A 69-year-old man presents with sudden onset of painless, DV in right eye of 1 weeks duration. BCVA was 20/200 OD and 20/25 OS with no afferent pupillary defect OD. He is diagnosed as CRVO case with diffuse macular edema. FA reveals retinal capillary non-perfusion in less than 10 disc areas and diffuse dye leakage in the fovea. OCT shows large cystic spaces with an increased foveal thickness of 495 μm.Based on the results of SCORE-CRVO trial, which of the following would be the best option for this patient?1. Intravitreal injection(s) of 1 mg triamcinolone2. Intravitreal injection(s) of 4 mg triamcinolone3. Intravitreal injection(s) of either 1 mg or 4 mg triamcinolone4. Observation Page 83 Retinal Vein Occlusion Mar 25, 2013
    84. 84. • Ans. 1 Page 84 Retinal Vein Occlusion Mar 25, 2013
    85. 85. …Continued case 1…• How would treatment differ if the patient is treated according to the CRUISE trial?1. Observation2. Single grid macular laser treatment3. Monthly intravitreal injections of an anti-VEGF agent4. Monthly intravitreal injections of a corticosteroidAns. 3 Page 85 Retinal Vein Occlusion Mar 25, 2013
    86. 86. …Continued case 1…• The treating physician opts for intravitreal injection of an anti-VEGF agent.Assuming an optimal response, what kind of improvement would the average patient expect if treated by monthly intravitreal ranibizumab for 6 months?1. 1-line gain2. 2-line gain3. 3-line gain4. 4-line gainAns. 3 Page 86 Retinal Vein Occlusion Mar 25, 2013
    87. 87. …Continued case 1…• In fact, in this case, vision in the right eye improves from 20/200 to 20/80 at 1 month. FT improves from 495 to 360 µm. There is no noted neovascularization.Which of the following should be considered if the treating physician follows the CRUISE trial protocol?1. Observation2. Intravitreal injection of an anti-VEGF agent and intravitreal injection of a corticosteroid3. Second injection of intravitreal anti-VEGF agent only4. Intravitreal injection of a corticosteroid only5. Macular grid laser Page 87 Retinal Vein Occlusion Mar 25, 2013
    88. 88. Ans. 3 Page 88 Retinal Vein Occlusion Mar 25, 2013
    89. 89. …Continued case 1…• If the same pt is to be treated by following CVOS protocol then what would be the be the Tx1. Prophylactic PRP2. Macular grid laser3. IVTA4. ObservationAns. 4 Page 89 Retinal Vein Occlusion Mar 25, 2013
    90. 90. …Continued case 1…• If this pt later develops I-CRVO & have macular edema but no signs of neovascularization. What would be the best option while following CVOS protocol.1. Immediate PRP2. PRP on next visit3. Macular grid4. IVTA5. ObservationAns. 5 Page 90 Retinal Vein Occlusion Mar 25, 2013
    91. 91. MCQ 2• Features that may help distinguish CRVO from carotid artery occlusive disease include all of the following except1. Dilated retinal veins2. Tortuosity of retinal veins3. Retinal artery pressure4. OphthalmodynamometryAns. 1 Page 91 Retinal Vein Occlusion Mar 25, 2013
    92. 92. MCQ 3• The most common risk factor for CRVO is1. Diabetes2. Hypertension3. Hyperlipidemia4. Smoking5. GlaucomaAns. 2 Page 92 Retinal Vein Occlusion Mar 25, 2013
    93. 93. True/false• Following are true about CRVO1. Hematological disorders are more common in pts <60 yrs age than those above 60 yrs2. Prognosis for younger pt is better than for older pts3. CVOS shows aspirin can prevent recurrence in affected or involvement of fellow eye4. CVOS show clear benefit of prophylactic laser Tx in ischemic eyes5. Macular grid laser is useful in presence of ME with VA 6/18Ans. T, T, F, F, F Page 93 Retinal Vein Occlusion Mar 25, 2013
    94. 94. True/false• The following conditions may cause central retinal vein occlusion in a young patient:1. protein C deficiency2. excess protein S3. Antithrombin III deficiency4. atrial fibrillation5. factor V Leiden mutationAns. T,F,T,F,T Page 94 Retinal Vein Occlusion Mar 25, 2013
    95. 95. Page 95 Retinal Vein Occlusion Mar 25, 2013
    96. 96. Next• Lecture – Dr. Yousaf Jamal • Retinal vein occlusion…continued• Journal club – Dr. Iqbal Page 96 Retinal Vein Occlusion Mar 25, 2013

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