100 day Glaucoma is seen in which of the following condition?
Correct Answer: Central retinal vein occlusion (CRVO)
Description: (A) Central retinal vein occlusion (CRVO)[?]Central Retinal Vein Occlusion:Typically large hypertensive 50+ year old women.Dilated exam reveals widespread haemorrhage & swelling (chronic diabetics look the same but the vision loss is not acute)Can be ischemic or non-ischemic.May progress to neovascularisation & rubeosis if untreated (the 100 day glaucoma). So follow-up is important.Retinal Vascular Occlusive Disorders:Central retinal vein occlusion accounted for 1/3 of all cases of NVI in one series.Approximately 50% of eyes develop NVG following ischaemic central retinal vein occlusion.Extensive peripheral retinal capillary non-perfusion on fluorescein angiography is the most valuable predictor of the risk of subsequent NVG.Glaucoma typically occurs 3 months after the occlusion (100-day glaucoma) but intervals from 4 weeks to 2 years have been documented.Eyes with ischaemic central retinal vein occlusions should receive panretinal photocoagulation (or cryoablation if no laser is available) to reduce the incidence of neovascular glaucoma.Careful follow-up is mandated even in those with the non-ischemic type because of the observation that one-third of eyes with central retinal vein occlusion and good perfusion at the onset show signs of ischemia by 3 years.CRVO Treatment:Change diuretics to other antihypertensive medications, if possible.Treat IOP if elevatedTreat underlying medical disordersMonitor carefully for neovascular glaucoma (90 day glaucoma)8-10% risk of developing CRVO or BRVO in fellow eye.CRVO Clinical Presentation:Asymptomatic, Decreased visionVisual loss: Sudden or gradualOver a period of days to weeks, Ranges from mild to severePatients can present with transient obscurations of vision initially, later progressing to constant visual loss. Photophobia, Redness of eyes, Painful blind eyeNEOVASCULAR GLAUCOMA OR 100 DAYS GLAUCOMAIt follows extensive retinal ischaemia.Most commonly seen in association with Central Retinal Vein Obstruction (CRVO) & Proliferative Diabetic Retinopathy.It develops between 2-4 months in about 50% of eyes.Pathophysiology: Occurs mainly due to presence of neovascularization over the iris (Rubeosis iridis)Sequelae leads to fibrosis - zip-like adhesions of iris to cornea at the angle.Optico ciliary shunts or optic disc collaterals signify a protective mechanism for anterior & posterior segment neovascularization.A difficult problem needs anti-VEGF agents, retinal photocoagulation or cryotherapy for eliminating the stimulus for neovascularization.Raised IOP treated by trabeculectomy along with antifibroblastic agents or Anterior Chamber Drainage ImplantLyle-wyber syndrome occurs in young patients un-efffected by systemic vascular disorders.
Category:
Ophthalmology
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