Central Retinal Vein Occlusion (CRVO) - Tomato Splash MCQ — NEET PG Practice Question | NEETPGAI
Central Retinal Vein Occlusion (CRVO) - Tomato Splash
medium
eye Ophthalmology
A 70-year-old man with a 15-year history of hypertension and open-angle glaucoma presents with sudden, painless, severe vision loss (counting fingers) in the right eye. Fundoscopy reveals the classic "tomato-splash" appearance with diffuse flame and dot-blot hemorrhages across all four quadrants (marked **A** in the diagram), along with a swollen hyperaemic disc, dilated tortuous veins, and cotton-wool spots. The patient undergoes fluorescein angiography at 3 months, which reveals ≥10 disc-areas of retinal capillary non-perfusion. Which of the following is the most important complication to monitor for in the next 3 months?
A. Optic nerve atrophy without any neovascular changes
B. Neovascular glaucoma (100-day glaucoma) due to anterior segment neovascularization
C. Immediate central retinal artery occlusion
D. Spontaneous resolution of all hemorrhages within 6 weeks
Explanation
Why Neovascular glaucoma (100-day glaucoma) due to anterior segment neovascularization is right
The diffuse 4-quadrant flame and dot-blot hemorrhages marked A, combined with ≥10 disc-areas of capillary non-perfusion on FFA, define ischemic CRVO. This is the high-risk subtype for anterior segment neovascularization and the dreaded complication of "100-day glaucoma" (neovascular glaucoma) arising approximately 3 months after onset. The severe retinal ischemia triggers VEGF release, leading to iris and angle neovascularization, which causes secondary angle-closure glaucoma. This is the most important complication to monitor for and prevent with anti-VEGF therapy (ranibizumab, aflibercept) or pan-retinal photocoagulation. [AAO BCSC Retina; CRUISE/COPERNICUS trials]
Why each distractor is wrong
Immediate central retinal artery occlusion: While CRVO involves thrombosis at the lamina cribrosa, the central retinal artery is not occluded in CRVO—only the vein is. CRAO is a separate entity with different presentation and worse prognosis. The question specifically describes CRVO, not CRAO.
Spontaneous resolution of all hemorrhages within 6 weeks: Ischemic CRVO has a poor prognosis and does not resolve spontaneously within 6 weeks. The hemorrhages and ischemic damage persist, and complications develop over months. This is a false reassurance.
Optic nerve atrophy without any neovascular changes: While chronic CRVO can eventually lead to optic atrophy, the immediate and critical complication in ischemic CRVO is neovascularization, not simple atrophy. Neovascular glaucoma is the sight-threatening emergency that requires urgent intervention.
High-YieldNEET PG
Ischemic CRVO (FFA ≥10 disc-areas non-perfusion, acuity <6/60, brisk RAPD) → monitor for 100-day glaucoma (neovascular glaucoma) → treat with anti-VEGF or PRP.
AAO BCSC Retina; CRUISE/COPERNICUS/GENEVA trials
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
