Beruflich Dokumente
Kultur Dokumente
Dr Kanav Gupta
29/07/09
1
Mrs Sakunbai Meshram, 45 Year old Female
with H/O…
GPDOV – LE>RE since 1 month
No H/O spectacles
2
Ophthalmic examination
3
Contd….
Fundus: RE – Media clear LE – No View
C:D : 0.3
B.V : mild venous tortuosuty,A.V.
changes present with A.V. ratio of 1:4
FR : Not seen
Hemorrhages from 6-9.30 o` clock involving macula
BP – 130/80mmHg
Pulse – 80/min
RR – 18/min
7
Lab Investigations
CBC – WNL
RBS – 90mg/dl
8
TREATMENT
Initially started with - I.V. Mannitol 100cc stat
T.Diamox 250 mg tds
Iotim 0.5% bd in LE
LE cataract surgery
9
Retinal Vein Occlusions
Morphology
CRVO
BRVO
Hemispheric VO
Hemicentral VO
Papillophlebitis
Macular BRVO
CENTRAL RETINAL VEIN
OCCLUSION
Mechanism :
» Conditions producing
a physical blockage
at the level of the
lamina cribrosa.
2. Hemodynamic factors
resulting in an
obstruction to the
flow of blood.
Rubeosis iridis develop in 50% between 2-4 months which may lead
to NVG.
FOLLOW UP
Monthly for 6 months to detect anterior segment neovascularisation,
angle neovascularisation (for risk of NVG)
Nonischemic Central Retinal
Vein Occlusion
Most common type
Peripheral BRVO
Clinical Features
VA depends on extent of macular involvement. Patients with
macular involvement presents with sudden onset of blurred vision
and metamorphopsia or a relative visual field defect.
Fundus: Dilatation and tortuosity of venous segment distal to site of
occlusion and attenuation proximally.
- Flame shaped, dot n blot haemorrhage, retinal
edema and occasionally cotton wool spots.
FA: Variable delayed venous filling
blockage by blood
Hyperfluorescence due to leakage
Hypofluorescence due to capillary non perfusion
Pruning of vessels in ischaemic areas
COURSE & PROGNOSIS
Acute phase resolves in 6-12 months and may be replaced by the
following:
- Hard exudates, venous sheathing and variable amount of residual
haemorrhage.
- Collateral venous channels characterised by slightly tortuous
vessels between inferior and superior vascular arcades.
Treatment:
Grid laser photocoagulation-(100-200 um, 0.1 sec duration
spaced one burn width apart, away from fovea and intraretinal
haemorrhages should be avoided. Follow up should be after 3
months.
Intravitreal Triamcinolone acetonide(a corticosteriod suspension
which reduces breakdown of blood retinal barrier) but its effect lasts
for only 6 months.
Vitrectomy with or without sheathotomy.
Neovascularization
NVD develops in 10% and NVE in about 25% of eyes within 6-12
months usually but may develop at anytime within first 3 years, only
in eyes that shows large area(>5 disc diameters in diameter) of
retinal capillary nonperfusion.
Fluorescence in the
macula indicates capillary
leakage and acute phase.
PAPILLOPHLEBITIS
In 1961, Lyle and Wybar described six young, healthy patients with
a unilateral, relatively benign condition characterized by mild
blurring of vision, essentially normal visual acuity, dilated and
tortuous retinal vessels, a varying amount of retinal hemorrhage,
optic disc edema and cotton wool spots.
All six patients improved spontaneously, but were left with sheathing
of retinal vessels and the formation of vessels on the optic disc. Lyle
and Wybar called this condition "retinal vasculitis" and believed it to
be due to a central retinal vein occlusion secondary to an
inflammatory vasculitis of the venous system.
Lonn and Hoyt agreed with this aetiology, but felt that
"papillophlebitis" was a more appropriate descriptive term.