Patients diagnosed with congenital retinal arteriovenous malformations frequently exhibit other angiomas across their bodies, creating an odd appearance with leakage on fluorescein angiography.

Hemorrhage is a potential side effect of central retinal vein occlusion (CRVO). Minocycline may prevent cells responsible for hemorrhage from becoming active, potentially helping prevent bleeding episodes from happening.

Causes

Hypertensive retinopathy‘s causes can generally be divided into two groups: those that disrupt vascular perfusion and those resulting in abnormal neovascularization. Artery occlusion, macular edema and subretinal hemorrhage may all disrupt perfusion; abnormal neovascularization often manifests itself via vitreous detachment, tractional retinal detachment or nonclearing vitreous hemorrhage can all increase neovascularization or subfoveal Neovascularization (CNV).

Obstruction in one or more retinal arteries that causes ischemia and restricts axoplasmic flow within the retinal nerve fiber layer, leading to ischemic conditions and restricting its ability to carry oxygen-rich blood supplies to it. Cystic macular edema manifests itself through thickening of inner retinal layers on optical coherence tomography; its source can often be identified using electrophysiologic testing (reduced b-wave amplitude and normal a-wave implicit time). Full-thickness retinal holes may also occur, which can be identified with a slit lamp exam as gaps or depressions in the center of the macula. Furthermore, Schafer’s sign (an oval pigment ring around the operculum) may often be observed as well. Vitreous gel forms around a tear to seal it shut and prevent retinal detachment, but can result in photopsias and floaters which move with eye movement. Retinal holes tend to form more often among people with high blood pressure, chronic ocular inflammation, sclerotic cataracts or prior trauma such as posterior vitreous detachments.

Opclusive retinal disease most frequently arises at arteriovenous crossings (arterially overcrossings where an artery and vein share a vascular sheath), most frequently by means of shunting, compression or occlusion; visual acuity in affected quadrants may decrease; funduscopy may show hemorrhages and cotton-wool spots with tortuous retinal veins; the severity of the obstruction may lead to microaneurysms, retinal neovascularization epiretinal membranes or even neovascular glaucoma while chronic obstruction may result in subretinal hemorrhages or vitreous detachment.

An irregular and diffuse hemorrhage found below the neurosensory retina or RPE that appears dark in color. This condition is most frequently found among people suffering from Sickle Cell Disease, Retinopathy of Prematurity, Eales’ disease and Choroidal Hemangioma as well as certain coagulopathies like Hemophilia.

Diagnosis

Ocular angina refers to sudden or gradual vision loss over days to weeks (85%), often with the appearance of an “apple-green spot” (1%) in the center of their field of vision, caused by optic nerve edema. Some patients will also experience eye pain, dull headaches (known as “ocular angina”) or impaired photoreceptor regeneration following exposure to bright lights (amaurosis fugax).

Diagnose the condition with a comprehensive eye exam including pupillary dilation, tonometry and anteriosomal gonioscopy. Furthermore, one should evaluate for hypertension, glaucoma and diabetes as possible causes. A complete blood count (CBC) and blood viscosity test may be conducted to evaluate for increased risk factors, and those suspected of nonischemic CRVO should generally visit a retina specialist for diagnosis and treatment. Fluorescein angiograms can assist with determining peripheral capillary nonperfusion and distinguishing between ischemic and nonischemic central retinal vein retinopathy, wide-field angiography being particularly helpful when assessing macular edema and cystic changes; while optical coherence tomography (OCT) provides monitoring capabilities to track cystic macular edemas and their potential neovascularization.

Hemorrhages of the retina are common among many eye conditions and may present themselves in various ways: dot/blot, spherical, or intraretinal hemorrhages are distinct types. When diagnosed with hypertensive retinopathy or vascular occlusive retinopathy, dot or blot hemorrhages typically appear around peripapillary and macular areas while feathery intraretinal hemorrhages confined to outer plexiform layers (Fig 10-2). They occur among patients suffering from diabetic retinopathy, hypertensive retinopathy, aortic arch disease parafoveal telangiectasia radiation retinopathy and Takayasu’s disease among others ocular conditions that include diabetic retinopathy as well as Takayasu’s disease among others (Fig 10-2).

Macular Edema typically affects patients over 50 years old with a male predilection; is linked with atherosclerosis, diabetes mellitus, hypertension, coronary artery disease or prior stroke; may result from systemic inflammation or angiogenesis; macular Edema results when capillary perfusion decreases due to tortuous retinal vessels which in turn decrease capillary perfusion resulting in macular Edema’s clinical course ranging from benign prognosis up to neovascularization with subsequent detachment in 33% of cases;

Treatment

Hypertensive retinopathy treatment primarily entails decreasing macular edema to improve visual acuity and overall visual acuity. There are various medications and surgical solutions available to reduce fluid build-up on the macula, helping reduce macular edema.

Steroids are among the most widely prescribed treatments for ocular edema in this condition, either orally or via injection into the eye. They may be taken once or twice a day with food; alternatively they may be included as part of a multi-drug regimen; prednisone and acetate are particularly commonly prescribed, although cyclosporine and methotrexate can also be helpful.

Other medications commonly used to treat ocular edema include ACE inhibitors, alpha blockers and diuretics. Diuretics help lower blood pressure by drawing excess water out of the body through ingestion or injection; topical solutions may also be combined with diuretics for greater effectiveness.

Available devices and methods for measuring photoreceptor function recovery in the retina. One method involves moving a fixed speed light source laterally across the fovea of a patient in dark adaptation state, instructing him or her to signal when no longer seeing light, and measuring time interval from when this blinding effect ended to when first detectable pulsing light (versus constant source) detected by patient. This method and device allow for evaluation of how well retinal structures recover after an initial over stimulation, providing information as to whether conditions progress, regress or require additional therapy.

Other symptoms of diabetic retinopathy include gray-white discoloration of the retina, commonly referred to as “whitening.” This condition results from retinal ischemia affecting outer retinal layers; areas of whitening that engulf all or parts of retina can either confined to macula area alone, or spread throughout retina. Corresponds to intracellular edema of Muller cells as well as disruption of inner nuclear layer; may correlate to intracellular edema of Muller cells as well as disruption of inner nuclear layer. Hemorrhages often occur both with diabetic retinopathy as well as with central or branch retinal vein occlusion affecting outer retinal layers; areas can range from macula only.