Retinal vein occlusion
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Dr KN POORNESH WGH 03.11.2004. RETINAL VEIN OCCLUSION. CLASSIFICATION. BRVO CRVO Major BRVO Non-ischemic Minor Macular BRVO Ischemic Peripheral BRVO Papillophlebitis Hemiretinal Vein occlusion . PATHOGENESIS.

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RETINAL VEIN OCCLUSION

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Retinal vein occlusion

Dr KN POORNESH

WGH

03.11.2004

RETINAL VEIN OCCLUSION


Classification

CLASSIFICATION

BRVO CRVO

Major BRVO Non-ischemic

Minor Macular BRVO Ischemic

Peripheral BRVO Papillophlebitis

Hemiretinal Vein occlusion


Pathogenesis

PATHOGENESIS

Arteriosclerosis

Compression of the vein

Venous endothelial cell loss

Thrombus formation

Venous Occlusion


Pathogenesis1

PATHOGENESIS

Venous occlusion  elevation of venous

& capillary pressure

   Stagnation of blood flow

 

Increased tissue pressure Hypoxia of the retina

 

Damage to capillary endothelial cells &

extravasation of blood constituents


Risk factors in order of importance

RISK FACTORS(in order of importance)

  • Advancing age: 50% cases over 65 yrs.

  • Systemic: HT, Hyperlipidemia, Diabetes, Smoking, Obesity.

  • Raised IOP: risk of CRVO

  • Inflammatory: Behcet’s, Sarcoid,AIDS, SLE, Toxoplasma.

  • Hyperviscosity: Polycythemia, MM, Waldenstrom macroglobulinemia.


Risk factors

RISK FACTORS

6. Acquired thrombophilic: Hyperhomocystinemia, Antiphospholipid antibody syndrome.

7. Inherited thrombophilic: increased levels of clotting factors 7 & 11, deficiency of antithrombin 3, protein C &S, resistance to activated protein C.

Other Risk factors:

•Hypermetropia (BRVO), Congenital anomaly of Central retinal vein (CRVO), Optic disc drusen,

• Drugs (OC, Diuretics), Migraine (rare).

• Retrobulbar external compression: Dysthyroid eye disease, Orbital tumor


Major brvo

Major BRVO


Course of brvo

COURSE of BRVO

6 to 12 months to resolve

• Venous sheathing

• Collateral venous channels

• Microaneurysms, Hard exudates, Cholesterol crystal deposition.

• Macula: RPE changes or

ER gliosis, chronic CME.


Prognosis and complications of brvo

Prognosis and Complications of BRVO

Depends on • Site & Size of occluded vein • Integrity of perifoveal capillary network

50% : Recover VA of 6/12 or better.

Complications: 1. Chronic macular edema

2. Macular ischemia

3. Neovascularisation,

NV (within 3 yrs)

10%- NVD, 20-30%- NVE

4. Recurrent VH, TRD.


Management of brvo bvos

Management of BRVO(BVOS)

Wait for haemorrhage to clear (3 months).

FFA :

  • Macular edema and VA 6/12 or worse after 3 months –grid laser & follow-up after 2-3 months.

  • Macular ischemia—no treatment.

  • 5 DD or > area of CNP– 4 monthly follow- up for 12-24 months.

  • Neovascularisation– scatter laser


Crvo ischemic non ischemic

CRVOIschemic Non-ischemic


Crvo ischemic non ischemic1

CRVOIschemic Non-ischemic


Non ischemic crvo course and follow up

Non-ischemic CRVO(Course and Follow-up)

Residual signs: Disc collaterals, epiretinal gliosis, pigmentary changes at macula.

Conversion to ischemic CRVO occurs in 15% of cases within 4 months and 34% within 3 years.

Follow-up: should be for 3 years.

Prognosis: depends on initial VA, near normal VA in 50%, Chronic CMO- unresponsive to laser (CVOS).

8-10% risk of BRVO or CRVO in the fellow eye.


Ischemic crvo management cvos

Ischemic CRVO:Management (CVOS)

Follow-up: monthly for 6 months

IOP, undilated gonioscopy & SLE

Angle NV is the best clinical predictor of NVG.

Treatment: PRP in eyes with angle or iris NV. Monthly follow-up until stabilisation or regression.


Hemiretinal vein occlusion

Hemiretinal vein occlusion

  • Less common than BRVO and CRVO

  • Occlusion of superior or inferior branch of the CRV.

  • Features of BRVO, involving the superior or inferior hemisphere

  • Prognosis depends on severity of macular edema and ischemia.


Papillophlebitis optic disc vasculitis

PAPILLOPHLEBITIS(Optic disc vasculitis)

  • Healthy individuals, < 50 years

  • Optic disc swelling with secondary venous congestion rather than venous thrombosis.

  • APD absent, retinal haemorrhages confined to posterior fundus.

  • Prognosis: 80% -- 6/12 or better

    20% visual loss -- macular edema


Management recent advances

Management:Recent advances

  • Recent onset of non-ischemic CRVO– high intensity laser to create chorioretinal shunt.

  • AV sheathotomy for treatment of CME due to BRVO.

  • Ischemic CRVO:- PP Vitrectomy + Intraocular gas + Radial neurotomy


Management recent advances1

Management: Recent advances

  • Intravitreal tPA

  • Transvitreal vein cannulation

  • Section of posterior scleral ring

  • Drug therapy -- Troxerutin

    -- Petroxyfylline

    -- Hemodilution

  • Intravitreal Triamcinolone


Retinal vein occlusion

Thank You


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