Term
| Who is most likely to suffer from Ocular Ischemic syndrome? |
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Definition
Men (67%)
Elderly (65 yr median) |
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Term
| What is a light induced amaurosis fugax? |
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Definition
Central scotoma when going outdoors --> indoors or exposure to light at night
Has dull, aching pain 40% of the time 'ocular angina' |
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Term
| How long does Light Induced Amaurosis Fugax last and what does it subjectively appear as? |
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Definition
| Several minutes; 'white haziness' |
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Term
| What are typical VA's for a LIA pt? |
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Definition
1/3 20/20 - 20/40
1/3 Finger counting or worse |
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Term
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Definition
gradual vision loss over 1-2 weeks
12% will be abrupt vision loss |
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Term
| What is Light Induced Amaurosis Fugax associated with? |
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Definition
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Term
| What SLE signs are present in Ocular Ischemic Syndrome? |
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Definition
sluggish pupil
ischemic uveitis w/ flare usually; 20% with cells
neovascularization of iris in 2/3 --> 50% of these have elevated IOP as a result |
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Term
| What poterior pole signs are present in OIS? |
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Definition
retinal artery narrowing
venous beading
retinal hemorrhages 80% of the time
MA than can lead to ME
NVD 1/3 of the time
decreased A and B waves on ERG |
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Term
| What dz's are OIS often comorbid with? |
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Definition
1/2 have DM
1/2 have ischemic heart dz
1/4 have prior CVA
20% have had bypass surgery
stroke
death from cardiac dz |
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Term
| How is OIS diagnosed and then managed? |
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Definition
| Carotid doppler ultrasound; referral to PCP and PRP if NVI |
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Term
| What is a typical CRVO pt? |
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Definition
>50 yo male
74% Carotid dz
57% HTN
DM 34%
Ocular HTN and OA Glaucoma are risk factors |
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Term
| What was the SCORE study and what was its conclusion? |
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Definition
| Intravitreal triamcinolone is effective for tx of CRVO |
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Term
| Which type of CRVO is less common but requires closer followup? Which has poorer VA prognosis? |
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Definition
| Non-perfused (ischemic) for both |
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Term
| What is the least reliable method for determining if a CRVO is ischemic or non-ischemic? |
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Definition
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Term
| What s/sx are commonly seen with ischemic CRVO? |
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Definition
extensive hemorrhages
CWS common
ONH swelling
ME
SVP abset |
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Term
| How much capillary non-perfusion is high risk for NVI secondary to a CRVO? |
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Definition
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Term
| How much capillary non-perfusion is low risk for NVI secondary to a CRVO? |
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Definition
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Term
| Why is FA limited in diagnosing CRVO? |
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Definition
hemorrhages block view
media opacities and small pupils common
peripheral non perfusion (which is what occurs first) not evaluated |
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Term
| What VA indicates 90% chance of ischemic CRVO? |
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Definition
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Term
| What VA breakpoint is associated with ischemic CRVO? Non-ischemic? |
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Definition
Vast majority worse than 20/400 in ischemic
60% better than 20/200 in non-ischemic |
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Term
| In Goldmann periphery VF, what isopter indicates non-ischemic? Ischemic? |
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Definition
Non-ischemic: can see V-4e and I-4e normally
If only V-4e can be seen, definitely ischemic |
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Term
| Using ERG, how is ischemic vs non-ischemic CRVO determined? |
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Definition
| B wave <60% of normal or reduced more than 1 or 2 SD of equipment --> ischemic |
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Term
| What are the neutral density cutoffs for diagnosing ischemic vs non-ischemic CRVO? |
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Definition
non-ischemic: 97% RAPD <0.6 log units
ischemic: 94% >0.9 log units; 91% >1.2 log units |
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Term
| For non-ischemic CRVO, what is the management plan? |
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Definition
Often will resolve in 6-12 months with time
F/U q 2 m X 7-8 m |
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Term
| What is a possible SE of non-ischemic CRVO that may be seen during follow up? |
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Definition
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Term
| For ischemic CRVO, what is the management plan? |
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Definition
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Term
| What are possible sequelae of ischemic CRVO? |
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Definition
vitreous hemes
macular degeneration
optic atrophy
loss of eye |
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Term
| If NVI is present after CRVO, what are the tx's? |
|
Definition
topical steroids
If IOP elevates FROM THE STEROID --> oral CAI, graduated cyclocryotherapy, topical glaucoma meds
PRP if NVG or retinal neo |
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