Term
| Term for ocular signs and syndromes secondary to severe carotid artery obstruction |
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Definition
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Term
| 3 common causes of ocular ischemic syndrome |
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Definition
Atherosclerosis
Giant cell arteritis
Diffuse systemic ischemia |
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Term
| Ocular ischemic syndrome involvement is generally ______lateral ocular and _____lateral carotid |
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Definition
| unilateral ocular involvement and bilateral carotid involvement |
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Term
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Definition
Light-induced amaurosis fugax
Dull, aching pain to orbit (ocular angina) |
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Term
| Term for: scotoma in central field when exposed to bright light following a dim environment, described as fuzziness or haziness that lasts several minutes |
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Definition
| Light induced amaurosis fugax |
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Term
| 3 clinical features of the anterior segment in OIS |
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Definition
Sluggish pupil (ischemia)
Ischemic uveitis (mostly just flare)
NVI in 67% |
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Term
| Why do only 50% of OIS patients with NVI have elevated IOP |
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Definition
| Ischemia is limiting the ability of the ciliary body to produce aqueous |
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Term
| 7 clinic features of the posterior segment in OIS |
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Definition
Retinal ARTERY narrowing
Retinal vein dilation/beading
MIDPERIPHERAL hemorrhages in 80% (KEY)
Macroaneurysms
NVD in 35%
Spontaneous ARTERY pulsation
Decreased a and b wave ERG |
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Term
| Pulsing artery means that during ______________ the pressure in the artery is _____________ than IOP |
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Definition
| Pulsing artery means that during diastole the pressure in the artery is lower than IOP |
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Term
| 4 systemic conditions associated with OIS |
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Definition
DM (>50%)
Ischemic heart disease
History of CVA
20% have required bypass surgery |
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Term
| How does ocular ischemic syndrome affect risk of heart attack |
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Definition
| 40% risk of heart attack DEATH in those who experience OIS |
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Term
| Which is more likely to have venous beading, diabetes or OIS |
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Definition
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Term
| Which is more likely to have hemes in the posterior pole, OIS or DM |
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Definition
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Term
| Describe how you should evaluate the carotid |
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Definition
| Listen for bruit, then feel for carotid pulse-listen high and palpate low |
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Term
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Definition
In office carotid evaluation
Carotid Doppler |
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Term
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Definition
Referral to PCP
PRP if NVI |
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Term
| After endarterectomy, what ocular sequelae do we need to monitor for? |
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Definition
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Term
| When is Carotid endarterectomy performed? |
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Definition
| In patients with 70-99% occlusion of the carotid, to prevent stroke |
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Term
| If NVI is present in OIS, what percentage of eyes are blind in 1 year? |
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Definition
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Term
| 3 systemic conditions commonly associated with CRVO |
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Definition
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Term
| Age and gender that most commonly experiences CRVO |
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Definition
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Term
| Conclusions of the SCORE study |
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Definition
| Using triamcinolone is better than observation when treating vision loss due to macular edema caused by CRVO. 1mg dose is safer than 4mg. |
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Term
| Name the 2 types of CRVO; which is more common? |
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Definition
| Perfused and Non-perfused, perfused is more common |
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Term
| Prognosis of Non-perfused CRVO |
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Definition
Permanent poor VA
VF defects
NVI and neovascular glaucoma |
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Term
| What is the most reliable test to determine if CRVO is perfused or non-perfused |
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Definition
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Term
| When doing fluorescein angiography, what is required for diagnosis of ischemic CRVO |
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Definition
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Term
| Describe what appearance of FANG would indicate high risk for NVI |
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Definition
| Eyes with >75 DD of capillary non-perfusion |
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Term
| Limitations of FANG in diagnosing CRVO perfusion |
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Definition
Retinal heme makes good imaging difficult (unable to ddx b/w non-perfusion and blockage)
Media opacities and small pupils
earliest non-perfusion starts in periphery, which is not viewed with FANG |
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Term
| In CRVO, VA of worse than ________ has over 90% chance of being ischemic |
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Definition
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Term
| Visual field result that would indicate "definitely ischemic CRVO" |
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Definition
| Eye can only see V-4e or no target |
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Term
| Visual field resutls that would indicate Non-ischemic CRVO |
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Definition
| Peripheral fields with V-4e and I-4e are normal (the 2 brightest targets) |
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Term
| Results of photopic and scotopic ERG that indicates Ischemic CRVO |
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Definition
| Bwave amp <60% of normals or B-wave is reduced by more than 1 or 2 SD |
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Term
| Grading of RAPD that is expected in non-ischemic CRVO (in log units) |
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Definition
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Term
| Grading of RAPD that is expected in ischemic CRVO (in log units) |
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Definition
| 94% have >0.9 log units, 91% have >1.2 log units |
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Term
| When measuring RAPD with neutral density filters, which eye do you place they filter over? |
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Definition
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Term
| 5 tests used to differentiate ischemic and non-ischemic CRVO |
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Definition
Measurement of RAPD
ERG
Visual Field
Visual Acuity
FANG |
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Term
| Main complication of perfused CRVO |
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Definition
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Term
| Side effects of triamcinolone injection |
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Definition
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Term
| How did anti-VEGF injections compare to sham trials in CRUISE and BRAVO studies |
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Definition
Rapid improvement in VA and CFT with anti-VEGF compared to sham
BRVO most improvement
Best with early intervention |
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Term
| 5 risks of intraocular injections |
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Definition
Retinal hemorrhages
subconj heme
Endophthalmitis
cataracts
Increased IOP |
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Term
| Results of study investigating use of intravitral dexamethasone implant for macular edema |
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Definition
Better vision and reduced CRT faster with treatment compared to sham through day 90, but no difference through day 180.
BRVO better response than CRVO |
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Term
| Follow up routine for management of Perfused CRVO |
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Definition
q2m X7-8months
assess stability of VA and development of ischemia |
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Term
| What time frame do you expect for resolution of retinopathy in Perfused CRVO |
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Definition
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Term
| What is the risk of conversion from perfused to non-perfused CRVO |
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Definition
| 33% of the time after 3 years, of 15% within 18months |
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Term
| Follow up routine for management of Non-perfused CRVO |
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Definition
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Term
| Long term sequelae of non-perfused CRVO |
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Definition
Ocular neovascualrization, esp. anterior segment
Vitreous hemorrhages
Macular Degeneration
Optic Atrophy
Loss of the eye |
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Term
| Management of NVI secodnary to CRVO |
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Definition
Topical steroids (anti-angiogenic properties)
Treatment of elevated IOP if necessary (topical glaucoma meds, oral CAIs, graduated cyclocryotherapy)
PRP if NVG or retinal neo |
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Term
| When do you consider using IOP lowering medications following CRVO |
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Definition
| Only when the pressure is high, no longer do it prophylactically |
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Term
| Chance of developing CRVO in the other eye |
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Definition
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