Retinal vascular disorders

 Retinal vascular disorders encompass a variety of conditions that affect the blood vessels of the retina, potentially leading to vision impairment or blindness if untreated. Here’s an overview of key retinal vascular disorders:

1. Diabetic Retinopathy

• Cause: Damage to retinal blood vessels due to chronic high blood sugar (diabetes).

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• Types:

  • Non-Proliferative (NPDR): Microaneurysms, hemorrhages, exudates.

  • Proliferative (PDR): Abnormal new vessel growth, leading to vitreous hemorrhage or retinal detachment.

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• Symptoms: Blurred vision, floaters, vision loss.

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• Treatment:

  • Tight glycemic control.

  • Laser photocoagulation (for PDR or macular edema).

  • Anti-VEGF injections (e.g., bevacizumab, ranibizumab).

  • Vitrectomy (in advanced cases).

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2. Retinal Vein Occlusion (RVO)

• Types:

  • Central Retinal Vein Occlusion (CRVO)

  • Branch Retinal Vein Occlusion (BRVO)

• Cause: Thrombosis in retinal veins, often due to hypertension, diabetes, or glaucoma.

• Symptoms: Sudden painless vision loss, retinal hemorrhages, macular edema.

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• Treatment:

  • Anti-VEGF therapy (first-line for macular edema).

  • Steroid implants (e.g., dexamethasone implant).

  • Laser therapy (for BRVO with ischemia).

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3. Retinal Artery Occlusion (RAO)

• Types:

  • Central Retinal Artery Occlusion (CRAO) (medical emergency).

  • Branch Retinal Artery Occlusion (BRAO).

• Cause: Embolism (e.g., carotid artery disease, atrial fibrillation), vasculitis, or thrombosis.

• Symptoms: Sudden, painless, severe vision loss (often irreversible).

• Treatment:

  • Immediate measures: Ocular massage, anterior chamber paracentesis, hyperventilation with carbogen.

  • Thrombolytics (controversial, time-sensitive).

  • Management of underlying cause (e.g., stroke workup).

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4. Hypertensive Retinopathy

• Cause: Chronic high blood pressure damaging retinal vessels.

• Signs:

  • Mild: Arteriolar narrowing, AV nicking.

  • Severe: Flame hemorrhages, cotton wool spots, papilledema (malignant hypertension).

• Treatment: Blood pressure control.

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5. Retinopathy of Prematurity (ROP)

• Cause: Abnormal retinal vessel development in premature infants (especially <30 weeks gestation).

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• Stages:

  • Stage 1-3: Mild to moderate vessel abnormalities.

  • Stage 4-5: Retinal detachment → blindness.

• Treatment:

  • Laser therapy or anti-VEGF injections for threshold disease.

  • Vitrectomy in advanced cases.

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6. Retinal Vasculitis

• Cause: Inflammation of retinal vessels due to autoimmune diseases (e.g., Behçet’s, sarcoidosis), infections (e.g., tuberculosis), or idiopathic.

• Symptoms: Floaters, blurred vision, retinal hemorrhages.

• Treatment:

  • Steroids (oral or intravitreal).

  • Immunosuppressants (e.g., methotrexate).

  • Treat underlying infection if present.

Diagnostic Tools:

• Fundus examination (hemorrhages, exudates, vessel abnormalities).

• Optical Coherence Tomography (OCT) (macular edema, retinal thickness).

• Fluorescein Angiography (blood flow abnormalities, leakage).

Key Takeaways:

• Diabetic retinopathy and vein occlusions are common and managed with anti-VEGF/laser.

• Artery occlusions require urgent intervention (but often poor prognosis).

• Systemic control (blood sugar, blood pressure) is crucial in prevention.