Retinal Vein Occlusion

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Doris Anthony
5 years ago
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1 Retinal Update 2018 Retinal Vein Occlusion Case Presentations to Myself

2 Branch Vein Occlusion What medical evaluation do you recommend for this 72 year old patient? Is there anything you ask of your medical consultant if this patient is 36 years old?

3 Branch Vein Occlusion Do you initiate Would a medical you treat evaluation this patient? in a 65 yo woman? 20/20 When do you see this patient in follow-up?

4 Branch Vein Occlusion Is this a twig vein occlusion or simply hypertensive retinopathy?

5 Branch Vein Occlusion Would you treat this patient with a twig vein occlusion and CME? 20/40 Does the vision influence what drug you use? If there is 20/20 vision, but CME, do you treat?

6 Branch Vein Occlusion What is your initial management of this patient? 20/80 Do you inject anti-vegf on a fixed schedule, PRN or or treat and extend?

7 Branch Vein Occlusion This pt has had 8 Lucentis injections Do you switch therapies? If you switch, to what therapy do you switch?

20/50 How long What will it combinations take for the hemorrhage do

8 Branch Vein Occlusion Do you use Is combination it possible to therapy treat with for laser? an acute BVO? 20/50 How long What will it combinations take for the hemorrhage do you use? to resolve, What is the role so that of steroid laser could in the be treatment used? of BVO?

9 Branch Vein Occlusion Do you treat a patient who presents with a chronic BVO differently? 20/200 What is your initial management of this eye?

for one for year 1 year Do you start treatment now or do

10 Branch Vein Occlusion 6860 y/o year pt with old man no CME followed followed without without treatment treatment for one for year 1 year Do you start treatment now or do you continue to follow? 20/20 How do you treat this patient?

11 Branch Vein Occlusion Do This you eye perform has received an OCT five on injections every follow-up of Avastin visit? 20/63 20/63 The exudate seems to have increased Is she getting worse?

12 Branch Vein Occlusion How do you treat and follow this patient with ischemic BVO? Do you hold off on PRP until there is VH or NVE? Do you ever treat ischemic retina with PRP in order to decrease the VEGF load prior to initiating injections?

13 Branch Vein Occlusion If you don t treat ischemia with PRP, what is your follow-up plan? Why does the inferotemporal quadrant have a different color?

14 What is subthreshold micropulse laser and does it have a role in the treatment of vein occlusion? Branch Vein Occlusion Do you treat near the fovea with laser?

15 Branch Vein Occlusion Does OCT-A have a roll in the management of BVO? Superficial Capillary Plexus Deep Capillary Plexus

16 BRVO/Quadrantic CRVO Is this a BVO or a quadrantic CRVO? Does it matter in terms of treatment? Do you consider the multiple CWS a poor prognostic sign for final visual acuity?

17 Central Retinal Vein Occlusion 78 yr old female with 20/20 vision Do you initiate any medial evaluation?

18 Central Retinal Vein Occlusion 39 yr old patient Do you initiate a search for clotting disorders? 20/20 Do you treat a CRVO with 20/20 vision?

19 Central Retinal Vein Occlusion What is your initial management in this 78 yo man? 20/100

20 Central Retinal Vein Occlusion Do you obtain an angiogram before initiating treatment? If a patient has an ischemic CRVO but no CME, do you treat?

21 Central Retinal Vein Occlusion Do you inject anti-vegf on a fixed schedule, PRN or Treat and Extend protocol? Do you treat until the macula is dry before extending the next injection?

22 Hemi Central Retinal Vein Occlusion Is the treatment of a hemi-crvo the same? Is the visual prognosis better?

23 Central Retinal Vein Occlusion If you treat and extend, and the patient comes back with recurrent CME after 8 weeks, do you inject and bring them back in 4 weeks? 6 weeks?

24 Central Retinal Vein Occlusion How long do you continue your initial treatment before you consider switching to another therapy? To what therapy do you switch?

25 Central Retinal Vein Occlusion Do you ever use combination therapy with CRVO? What combination do you use? 20/160 Do you use steroids in the management of CRVO?

26 Central Retinal Vein Occlusion If this patient has had filtering surgery and is pseudophakic, are you more willing to use Ozurdex? Do you treat the patient first with Triescence or PST Kenolog?

27 VEGF Levels in Ischemia Lucentis shown to be superior to Avastin in its affinity and ability to bind VEGF-A CRVO are usually more ischemic than BVO What is the role of Avastin in the treatment of CRVO?

28 Central Retinal Vein Occlusion Have you been able to reduce the treatment burden by using Eylea? If Eylea injections are required every month, how long before you switch to something else?

29 Central Retinal Vein Occlusion Do you perform a fluorescein angiogram prior to stopping anti-vegf treatment? Have you ever found a surprising amount of ischemia? If you find ischemia, how do you treat?

30 Central Retinal Vein Occlusion This patient has had total resolution of her CME Why isn t the vision better? 20/200 20/100 Was there simply more ischemia than we had thought?

31 Central Retinal Vein Occlusion and Rubeosis What is your management? CF

32 Central Retinal Vein Occlusion and Rubeosis If an eye with rubeosis undergoes PRP, and has CME, how do you treat?

33 Bilateral Hemi-CRVO If a patient has bilateral central vein occlusion, do you initiate additional testing? What is the differential diagnosis of a bilateral CRVO?

34 Vitreomacular Traction and ERM following CRVO 20/100 Would you consider surgery or attempt medical treatment first?

35 CRVO and Cilioretinal Artery Occlusion What is the pathophysiology of this condition? What is the management of this patient?

36 Mild CRVO with Perivenular Whitening Inner retinal hyper-reflectivity, intraretinal and subretinal fluid 8/200 Why does such a mild CRVO cause such visual loss? 20/20 What is the prognosis?

37 CRVO with AV Malformation What causes the CRVO?

38 Retinal Update 2018 Retinal Vein Occlusion Case Presentations to Myself

39 Ocular Ischemic Syndrome presenting as CRVO 75 yo man with 80% occlusion of carotid artery How often does OIS present as a CRVO? Does carotid doppler study have a role in CRVO management?

40 Central Retinal Vein Occlusion

41 Central Retinal Vein Occlusion 20/20

Retinal Vein Occlusion (RVO) Treatment pathway- Northeast England. Retinal Vein Occlusion (RVO) with Macular oedema (MO)

Retinal Vein Occlusion (RVO) Treatment pathway- Northeast England (Royal Victoria Infirmary, Sunderland Eye Infirmary, James Cook University Hospital, Darlington Memorial Hospital, University Hospital