A 32 year old lady presented with a CRVO and macular odema.
Her VA and OCT improved after treatment with anti-VEGF Ranibizumab, (the patient was not pregnant at the time).
Question
1) What investigations would you request on presentation?
Answer
Investigations are aimed at identifying treatable risk factors for atherosclerosis, and conditions that cause hyperviscosity/slow/turbulent flow through retinal veins
Guidelines below were taken from the Royal college of Ophthalmologists document on the management of RVO.
Blood pressure - hypertension
FBC - Blood disorders
ESR - inflammation/myeloma
U&E - renal pathology
Glucose - diabetes
lipids - hyperlipidaemia
Additional tests for younger patients (where vascular risk factors are less likely)
Anticardiolipin, Lupus anticoagulant - Antiphospholipid syndrome (based on past medical and obstetric history)
Homocysteine - hyperhomocysteinaemia
Thrombophilia screen (protein C, protein S, antithrombin, factor V) - based on past medical history
Systemic inflammatory disorders: ANCA - Wegners, PAN, ACE - Sarcoidosis, Behcets