central-retinal-vein-occlusion-pathogenesis-and-clinical-findings

central-retinal-vein-occlusion-pathogenesis-and-clinical-findings

Central Retinal Vein Occlusion: Pathogenesis and clinical findings
Diabetes Orbital Disease Central retinal artery (i.e. Graves, tumors, AV fistulas) atherosclerosis and hardening Dyslipidemia • Hypertension
Hypercoagulable states (i.e. Polycythernia, Multiple myeloma, APLA syndrome, Antithrombin III def., Protein C or S def., factor V Leiden, OCP)
If anticoagulation and/or T coagulation mediated thrombus formation
Compression of the central retinal vein in the region of the lamina cribosa
Optic neuropathy causes retinal vein distortion in the lamina cribosa

Venous stasis mediating thrombus formation
Glaucoma
Authors: Graeme Prosperi-Porta Reviewers: Stephanie Cote Usama Malik Johnathan Wong* * MD at time of publication
Abbreviations: • APLA — anti-phospholipid antibody • OCP — Oral contraceptive pill • SLE — Systemic Lupus Erythematosus • VEGF — vascular endothelial growth factor • ERG — Electroretinography • RAPD — Relative afferent pupillary defect
Endothelial Damage mediating Vasculitis thrombus formation (i.e. sarcoidosis, syphilis, SLE)
RAPD <0.6 AL`intraluminal Central Retinal Vein Occlusion (CRVO) ERG <60% Non-ischemic CRVO ----*4 Normal b-wave • log units Visual Fields amplitude Moderate 1, visual acuity often >20/400 ERG >60% Vascular wall integrity is lost venous pressure b-wave amplitude hemorrhages 4 quadrant flame Venous capillary fluid/protein leakage Vascular wall integrity is lost Dilated “blood tortuous and thunder” retinal veins Mild retina, Few scattered Retina, macula macula and Intra-retinal and disc edema disc Edema hemorrhages
Legend:
Pathophysiology Mechanism
Sign/Symptom/Lab Finding
Complications
Ischemic ‘1 intraluminal venous pressure CRVO -110. RAPD >0.9 1, capillary perfusion log units Severe 4, visual acuity often <20/400 Retinal lschemia 1' VEGF Visual field deficits 1 fluid/proteins leakage Nerve layer damage Cotton wool spots Angiogenesis Neovascular glaucoma Vitreous hemorrhage