Case 5-2. Branch Retinal Vein Occlusion

Clinical Summary

A 66-year-old man had an occlusion of the superior branch retinal vein in his left eve. His visual acuity was j J

20/70 in this eve. Dilated fundus examination (A) showed a dilated and tortuous superotemporal retinal vein with surrounding intraretinal hemorrhage and significant macular edema- Late leakage of fluorescein dye was observed on angiography (B) and was most prominent in the temporal aspect of the superior hemisphere. Focal laser photocoagulation treatment was performed and the patient was examined one month later

Optical Coherence Tomography

A sequence of horizontal tomograms (C) delineated increased retinal thickening superotemporal to the fovea, with reduced reflectivity corresponding to serous fluid accumulation preferentially in the outer retinal layers, he retinal thickness directly in the fovea was 320 urn and increased superiorly as expected. Scan B, taken directly through fixation/ identified an intraretinal cyst temporal to the center, and a small detachment of the neurosensory retina just beneath the fovea. Intraretinal hemorrhages appeared as focal areas of bright, intraretinal backscatter-ing which partially shadowed the reflections from the retinal pigment epithelium and choriocapillaris below scan C, arrow).

Retinal Vascular Occlusion

Case 5-2 continued

Follow-up Examination

Two months later, a follow-up examination indicated persistence of the macular edema and the patient received additional focal laser photocoagulation in his left eye. The eye was re-evaluated after one additional month. The visual acuity had improved slightly to 20/60. Persistent edema and hemorrhage were noted in the distribution of the superotemporal vein on ophthalmoscopy (D).

Follow-up Optical Coherence Tomography

A follow-up set of OCT images (E) demonstrated a significant reduction in retinal thickening and fluid accumulation superotemporally Only a mild decrease in macular thickness was observed in the fovea, however, accounting for the lack of significant improvement in visual acuity, The central foveal thickness was 240 (im.

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