RETINAL VEIN OCCLUSION

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RETINAL VEIN OCCLUSION
Epidemiology
51 gt65y 10-15 lt45y ?? Afro-caribbean and Asian
descent in UK
Pathogenesis Primary retinal venous disease/
endothelium Thrombus secondary event
(Hypercoaguability)
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AETIOLOGICAL CONDITIONS
COMMON SYSTEMIC LOCAL
1. BP Glaucoma
2.Hyperlipidemia Trauma
3.DM Orbital lesions
4.Smoking Oedema-drusen optic disc
RARER 1.MM and Waldestrom 6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
2.CRF 6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
3.Vasculitis 6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
4.Thrombotic disorders 6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
5. Oral contraceptives (oestrogen)/ no HRT 6.Secondary causes of 1, 2, 3 such as acromegaly cushing, hypothyroidism
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DIAGNOSIS

1. Painless loss of vision- unilateral
2. Asymptomatic

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BRVO
Arteriovenous crossings Macular branch (DD from
diabetic maculopathy)
ACUTE CHRONIC
Haemorrhages Venous sheathing
Retinal oedema Exudates
Cotton wool spots Collaterals
Tortuous veins CMO
gt5 dd non-perfusion NVE
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CRVO
ACUTE CHRONIC
Dilated tortuous retinal veins Swollen optic disc Intraretinal haemorrhage Cotton wool spots Retinal oedema Sheathing of veins Absorption of haemorrhage Disc collaterals Macular oedema
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MECHANISMS OF VISUAL LOSS
Ischaemic (direct- indirect) Exudative (macular
oedema)
30 non-isch. Convert to ischaemic type first 4/12
Eyes at High Risc for Ischaemic Complications
1.RAPD 2. ??? VA 3. FFA gt10DD, 5-10 DD 4.Cotton
wool spots gt10, 5-10 5. Deep dark haem.
(infarct) 6. Elderly ( rubeosis)
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DIFFERENTIAL DIAGNOSIS
1.Accelerated hypertension 2.DM 3.Slow-flow
retinopathy 4.Peripapillary telangiectasia 5.
AION 6.Lupus/ radiation retinopathy 7. CMV
retinitis 8.Ocular ischaemic syndrome
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MEDICAL INVESTIGATIONS
ALL PATIENTS FBC, ESR, UE, LFT, GLC, Lipid
profile Protein electrophoresis ECG TFT MORE
SPECIALISED CXR Cardiolipin, Lupus
anticoagulant CRP, ACE, FTA-ABS RF, ANA, DNA,
ANCA MRI orbit, brain
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MANAGEMENT OCULAR
BRVO Argon laser for macular oedema if foveal
vasculature intact (FFA), VA 6/12-6/60 3-6/12
after the initial event Sectoral PRP for
proliferative complications or if areas of
non-perfusion gt5DD FU 6/52, up to 2years after
(collaterals)
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CRVO Prevention of neovascularisation Grid no
benefit FFA and Laser haemorrhages sufficiently
resolved Monthly FU/ total of 2years gt40DD
PRP 10-40DD no lt10 (non-ischaemic)
no Non-ischaemic cases convert to ischaemic 13
6/12 18 18/12 CHECK RAPD ALWAYS IN FU
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• MEDICAL
• Maximise visual outcome
• ? cardiovascular morbidity/ mortality (risk
  factors)
• Prevent recurrence to other eye (15 over 5
  years) Aspirin/ dipyridamole