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Branch Retinal Vein Occlusion

Bvo Branch Retinal Occlusion


Presentation

  • Branch retinal vein occlusion (BRVO) associated with ocular tuberculosis (TB) is a rare presentation of retinal vasculitis but it can also present in the absence of active uveitis.[ncbi.nlm.nih.gov]
  • A 33-year-old white man presented with a BRVO in the left eye.[ncbi.nlm.nih.gov]
  • A retrospective review of 3 patients presenting with clinical features of BRVO and evidence of vitreoretinal traction at the occlusion site was conducted. All patients presented with mild vitreous hemorrhage.[ncbi.nlm.nih.gov]
  • A 61-year-old man presented with 20/200 vision in the right eye because of a branch retinal vein occlusion secondary to a RAM.[ncbi.nlm.nih.gov]
  • The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location.[ncbi.nlm.nih.gov]
Aspiration
  • The case was managed using lens aspiration with pars plana vitrectomy and IOFB removal. We only found two previous reports of such a foreign body causing a vascular occlusion.[ncbi.nlm.nih.gov]
Insect Bite
  • Case report of a 60-year-old woman who complained of fever, chills, headache, lymphadenopathy, and blurred vision in the right eye following an insect bite to the lower right forehead.[ncbi.nlm.nih.gov]
Blurred Vision
  • Case report of a 60-year-old woman who complained of fever, chills, headache, lymphadenopathy, and blurred vision in the right eye following an insect bite to the lower right forehead.[ncbi.nlm.nih.gov]
  • Description: A picture of three older adults which goes blurry as the script mentions blurred vision.[noweyeknow.ca]
  • Patients typically complain of a sudden onset of blurred vision or defect in their central field of vision.[ellsretina.com]
  • If the veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause blurred vision. There is no cure for BRVO. Finding out what caused the blockage is the first step in treatment.[bostonlaser.com]
  • The leakage of fluid and bleeding causes the macula to swell leading to blurred vision and parts of vision missing.[gladesvilleeye.com.au]
Retinal Pigmentation
  • The pigmented intraretinal lesion proved to be a localized area of retinal and choroidal neovascularization with anastomosis and secondary retinal pigment epithelial hyperplasia.[ncbi.nlm.nih.gov]
  • The total retinal thickness was defined as the distance between the vitreoretinal interface and the inner surface of the retinal pigment epithelium.[journals.plos.org]
  • Normally laser light is absorbed by the pigment of the retinal pigmented epithelium and converted to heat resulting in damage to photoreceptors with sparing of the overlying retina.[touchophthalmology.com]
Corneal Edema
  • Slit lamp exam revealed diffuse corneal edema in her right eye, which had an IOP of 56 mmHg. After administration of intravenous mannitol, the IOP fell to 14 mmHg and the corneal edema disappeared.[ncbi.nlm.nih.gov]
Night Blindness
  • The normal complement of rod and cone photoreceptors supports the view that the night blindness in this case was an abnormality in the neural transmission and not on a morphological basis.[ncbi.nlm.nih.gov]
Retinal Cyst
  • The status of ellipsoid zone (EZ), external limiting membrane (ELM), outer retinal cyst, and inner retinal cyst was also evaluated.[ncbi.nlm.nih.gov]
Suggestibility
  • Intraretinal hemorrhages were distributed in an unusual linear pattern along the involved venous segment, suggesting the presence of vitreoretinal traction.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The results suggest the choroidal thickness in BRVO varies according to the type of macular edema.[ncbi.nlm.nih.gov]
  • We suggest that constant rubbing of endothelial cells of the occluded vein results in damage and erythrocyte extravasation was caused by diapedesis.[ncbi.nlm.nih.gov]
  • Funduscopy and fluorescein angiography suggested an intravascular thrombus as the cause of the occlusion. The investigations performed were positive for systemic hypertension and hyperlipidaemia.[ncbi.nlm.nih.gov]
  • These findings suggest that inflammatory factors may influence the recurrence of ME in BRVO patients, and that PDGF-AA might be a useful indicator of the number of IRIs required to control ME. 2016 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
Waardenburg Syndrome
  • We believe that these patients have Waardenburg syndrome, that branch retinal vein occlusion in case II-2 may be caused chiefly by systemic hypertension, and that elevated intraocular pressure associated with the blue iris may be partly involved in the[ncbi.nlm.nih.gov]

Workup

  • This patient did not have a thrombophilia workup. When ordering medical tests, consider how the result will alter treatment. RVO has only two treatment options when the thrombophilia workup is positive.[retina-specialist.com]
Pericardial Effusion
  • Medical history included bronchial asthma, history of allergy, eosinophilic pneumonia, bilateral pleuric and pericardial effusion, hypereosinophilia, and purpuric vasculitis.[ncbi.nlm.nih.gov]
Hypertriglyceridemia
  • Management of the hypertriglyceridemia with medication, exercise, and dietary modification resolved the lipemia retinalis and was associated with improvement in visual function.[ncbi.nlm.nih.gov]
  • Treatment The treatment of a non-ischemic BRVO includes a complete medical work-up looking into underlying causes such as hypertension, hypercholesterolemia, or hypertriglyceridemia.[retinacenternj.com]

Treatment

  • Argon laser treatment may improve visual acuity in I-BRVO even with severe ischaemia extending into the FAZ. Treatment intensity must be sufficient to destroy ischaemic retina.[ncbi.nlm.nih.gov]
  • SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing macular grid laser photocoagulation treatment to another treatment, sham treatment or no treatment.[ncbi.nlm.nih.gov]
  • In view of the uncertainty of the outcome of the natural history of BRVO, the abbreviated morbidity and the diminution of secondary complications observed following argon laser treatment, early treatment seems to be appropriate for patients suffering[ncbi.nlm.nih.gov]
  • Outcome in terms of visual recovery and decrease in central macular thickness on the Optical Coherence Tomography (OCT) from pre-treatment level was analysed at 6 and 12 months from starting of treatment and compared between the two groups.[ncbi.nlm.nih.gov]
  • SETTING: A Bayesian network meta-analysis of RCTs of treatments for macular oedema secondary to BRVO.[ncbi.nlm.nih.gov]

Prognosis

  • PPV may improve perifoveal microcirculation and the visual prognosis in BRVO patients with macular edema.[ncbi.nlm.nih.gov]
  • The prognosis of patients with BRVO and SRD requires further investigation.[ncbi.nlm.nih.gov]
  • Multiple regression analysis and multivariate logistic regression analysis were conducted, respectively, to identify independent predictors of visual acuity (VA) prognosis and risk factors for refractory ME longer than 1 year.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: These findings suggest that the aqueous flare is associated with inflammatory factors/cytokines, and that the change of the aqueous flare value may influence the long-term prognosis in patients with BRVO receiving IRI therapy for macular[ncbi.nlm.nih.gov]
  • Prognosis While a branch retinal vein occlusion may look to an eyecare practitioner to be much more serious than a branch retinal artery occlusion, the visual outlook is usually much better in the former.[waterdownoptometric.ca]

Etiology

  • We reviewed cases in literature and combined possible etiologies. We report a previously unpublished case of retinal artery occlusion following the use of intravitreal bevacizumab.[ncbi.nlm.nih.gov]
  • Etiology is caused from increased intracranial pressure rather from a vascular etiology Radiation Retinopathy There is a history of radiation therapy. Patients will have disc swelling and retinal neovascularization, and cotton wool spots.[decisionmakerplus.net]
  • Contents• BRVO – Demographics – Pathogenesis – Etiology – Management • Hx, examination, investigation • Treatment – Trials – Guidelines• HRVO• Summary / Take Home Message• MCQs Page 2 Retinal Vein Occlusion Mar 16, 2013 3.[slideshare.net]
  • (Etiology) Retinal Vein Occlusion (RVO) occurs when a blood clot blocks the retinal vein. Its exact cause is unknown.[dovemed.com]
  • The entity rarely occurs idiopathically, rather it is frequently associated with systemic coagulopathy, hyperviscosity, infection, inflammation, hypertension, diabetes mellitus, dyslipidemia, antiphospholipid antibody syndromes, cardiac and carotid etiologies[reviewofoptometry.com]

Epidemiology

  • Epidemiology [ edit ] BRVO is 4 times more common than CRVO. Usual age of onset is 60–70 years.[en.wikipedia.org]
  • Epidemiologic studies have found that uric acid can independently predict the development of hypertension, as well as stroke and heart failure [ 5 ].[omicsonline.org]
  • The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000. 98:133-41; discussion 141-3. [Medline]. Christoffersen N, Gade E, Knudsen L, Juel K, Larsen M.[emedicine.medscape.com]
  • Meta‐analysis of observational studies in epidemiology: a proposal for reporting. Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000 ; 283:2008–2012. Crossref Medline Google Scholar 18 Stang A.[jaha.ahajournals.org]
  • Authors’ Affiliations (1) Department of Ophthalmology, Inselspital, University of Bern, Switzerland References David R, Zangwill L, Badarna M, Yassur Y: Epidemiology of retinal vein occlusion and its association with glaucoma and increased intraocular[bmcophthalmol.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • "Retinal vein occlusion: pathophysiology and treatment options". Clinical ophthalmology (Auckland, N.Z.). 4 : 809–16. doi : 10.2147/opth.s7631. PMC 2915868. PMID 20689798. Rogers, S; et al. (Feb 2010).[en.wikipedia.org]
  • […] issue), Wong and Scott did not discuss the potential role of anticoagulants, particularly low-molecular-weight heparins, in the treatment of retinal-vein occlusion, a common condition for which there is no universally accepted therapy. 1 Although the pathophysiology[nejm.org]
  • PATHOPHYSIOLOGY In the early stage of RVO there are changes in blood flow and in the dynamics of circulation.[retinatoday.com]
  • Factors contributing to this pathophysiology include: Advancing age. Systemic conditions such as hypertension (found in 64% of patients with RVO ), hyperlipidaemia, diabetes, smoking and obesity. Raised intraocular pressure.[patient.info]
  • Pathophysiology Hypertensive, atherosclerotic, inflammatory, or thrombophilic conditions may lead to retinal endothelial vascular damage. In eyes with an anatomical predisposition, intravascular thrombus formation may occur.[emedicine.medscape.com]

Prevention

  • In addition, she was treated with lubricants for exposure keratopathy and a dorzolamide/timolol eyedrops to prevent increases in intraocular pressure.[ncbi.nlm.nih.gov]
  • Alternative therapy to suppress microaneurysms should be considered to prevent refractory ME in patients with BRVO.[ncbi.nlm.nih.gov]
  • Aflibercept acts as a soluble decoy receptor, binding with high affinity to vascular endothelial growth factor (VEGF)-A and placental growth factor (PIGF), preventing these angiogenic factors from binding to and activating their cognate receptors.[ncbi.nlm.nih.gov]
  • Progression to an ischemic status may possibly be prevented with successful anastomosis formation. Marked visual improvement may occur.[ncbi.nlm.nih.gov]
  • This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office.[hawaiivisionspecialists.com]

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